2025 Thankscrimmage Player Registration

Thankscrimmage is a day of giving thanks for Derby. It is a day of fun that shows our gratitude to all that is Derby, celebrating Refs, NSOs, Skaters, coaches announcers, photographers and most of the fans. Scrimmages will be listed based on skill level. Skaters: Your registration grants access to all qualified skill level scrimmages. Fill out a form for each player. Pre-Registering guarantees your seat. CORONA Rinks 11/29/2025 . Doors Open at 9:15AM First Whistle blows at 10AM

TIMES ARE SUBJECT TO CHANGE
Real Full Name*

First NameLast Name
Skater Name
Skater Number
League Affiliation *
Type NA if no League Affiliation
Skill Level
Pick one*

Adult SkaterJunior Skater
Birth Date

MonthDayYear
Insurance Carrier (WFTDA, USARS or Other) *

List insurance carrierInclude insurance number
Phone Number

Area CodePhone Number
E-mail
List Teams that you are rostered on (Only 3 max allowed per skater until the day of the event) See Face Book Event page for google doc sign ups or PCRD Website
Team 1
Team 2
Team 3
Emergency Contact

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
Note: Your roster spot will not be saved unless you are registered and skater fee paid.
Pass Type

ADULT VIP All Bout Access - Cashless Transactions via PayPal $65 Early Bird Special ( Goes back to regular price $75 on 11/1) 3 Pre Registered, ALL ACCESS TO ALL BOUTS and VIP RoomADULT SKATER: Cashless Transactions via PayPal - $40 Early Bird Special (Goes back to $50.00 on 11/1) - 3 Pre- Register / Unlimited day offJUNIOR SKATER: Cashless Transactions via PayPal $20 Early Bird Special ( Goes Back to $30.00 on 11/1)JUNIOR SKATER with Parent Officiating- Free (must volunteer majority of day, 1 skater per parent)

Payment: PAYPAL ONLY and Mark all that apply. Non-refundable and Non-transferable. Registration is not complete unless payment is received

PAYPAL ADULT VIP All Bout Access$65.00

This Pass will allow you to jump in any bout in your skill level, even if it is full. You will also have access to VIP Room. EARLY BIRD PRICE ends 11/1 Normal Price $75

PayPal Adult Skater Registration $40.00

Adult Skater Pass- Pre- Register for 3 ahead of time. The day of you may jump in any open spots. EARLY BIRD SPECIAL ends 11/1 and returns to $50

PayPal Junior Skater Registration $20.00

Junior Skater Pass- Early Bird Special end 11/1 and goes back to $30

Junior Skater With an Officiating Parent$ Free

Only 1 skater per Officiating parent

Enter coupon

For Junior Skater with an officiating parent please list Officals Name
****FOR JUNIOR SKATER PARENT ONLY- Please type parent or legal guardian name and attest that parent or legal guardian agrees to the below ***
I acknowledge that Thankscrimmage 2025 is a skate at your own risk event not sanctioned by USARS or WFTDA. I am responsible for my own medical bills and carry my own medical or accident insurance. I do not hold Prison City Roller Derby or The Rinks liable for my injuries during my participation in this event.*

I agree
By Agreeing here you consent and give permission to Prison City Roller Derby("PCRD"), it's authorized photographers and the RINKS at Corona Inline to use your photographed images in publications which can include but is not limited to websites, social media, posters etc... I do not agree to the use of my image for resale or in a manner that would exploit or cause malicious representation to me or PCRD*

I agree
By Agreeing here you commit to the following: 1. Treating all athletes, fans, volunteers and officials with respect 2. Support an inclusive environment, free from discrimination, harassment or offensive language. 3. Prioritizing the physical and emotional safety of everyone in this event. 4. acting professionally, sportsmanlike, respectful while representing pr participating in a Prison City Roller Derby Event 5. Following event rules and reporting unsafe or concerning behavior to leadership

I Agree
Any special notes to PCRD. Example buying a ticket for someone else, list name .
Thank you for participating in the 2025 Thankscrimmage ! Please submit form. If you chose the PayPal option, it will bring you directly to the PayPal site if you do not have paypal and wish to get early access , email prisoncityrollerderby@gmail.com
Should be Empty:

List Teams that you are rostered on (Only 3 max allowed per skater until the day of the event) See Face Book Event page for google doc sign ups or PCRD Website

Note: Your roster spot will not be saved unless you are registered and skater fee paid.

Thank you for participating in the 2025 Thankscrimmage ! Please submit form. If you chose the PayPal option, it will bring you directly to the PayPal site if you do not have paypal and wish to get early access , email prisoncityrollerderby@gmail.com