Come & Try Day Registration
Register to Claim Your Space
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Full Name *
Email Address *
Phone Number *
Date of Birth (Must be over 16 years) *
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DD
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Residential Address *
Emergency Contact 1 *
Emergency Contact 2 *
Do you have any relevant medical conditions which we might need to know about?
Do you have any previous skating experience?
SKATES & SAFETY GEAR
We will have protective gear and roller skates available to borrow for this session.
If you do want to bring your own gear please feel free to do so! Fill in these sections so we can allocate equipment for you.
YOU MUST SKATE IN THE FOLLOWING; Helmet, Elbow and Knee Pads, and Wrist Guards.
If you require loan skates, what is your regular shoe size?
Clear selection
Do you need to borrow a helmet for the day? *
Do you need to borrow knee pads? *
Do you need to borrow elbow pads?
Clear selection
Do you need to borrow wrist guards?
Clear selection
SOCIAL MEDIA & WEBSITE AGREEMENT
I give authority to Van Diemen Rollers to use my image or video in promotional material and on the Van Diemen Rollers' public Facebook page + website: *
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