2024 New Recruit Sign-Up
We're so excited that you're interested in roller derby! Don't forget to hit SUBMIT at the end!
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First name *
Whatever name you want to be called
Last name *
Your pronouns (if any)
e.g. she/her, he/him, they/them (optional)
Email *
Phone number *
We practice on Thursdays from 7:15-9:15pm in Greenfield. What date might you be interested in attending? *
City/town you live in *
Date of birth *
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DD
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Do you have proof of primary health insurance? *
You must have primary health insurance to skate with us.
What sort of roller derby role are you interested in?
Please check all that apply.
What is your roller skating experience level? *
Emergency contact name and relationship to you *
Emergency contact phone number *
How did you hear about us?
To join in you'll need quad skates, derby-approved helmet, knee pads, elbow pads, and wrist guards. We have a limited amount of loaner gear we will give out on a first-come, first-served basis. If you are hoping to borrow gear, please comment here what gear you need (include shoe size if you're hoping to borrow skates). 
We strive to be a welcoming and inclusive community rooted in collaboration, equity, safety, and joy for our sport. Please take a moment to check out our code of conduct at pioneervalleyrollerderby.com/code-of-conduct and then reply below. *
What else would you like us to know?
Submit
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