My Bloody Valentine 2026 Registration Form & Waiver
  • My Bloody Valentine 2026 Registration Form & Waiver

    My Bloody Valentine 2026 Registration Form & Waiver

  • Our bloody hearts are full—and so are our rosters!

    You can still use this form to sign up for the waitlist. 

    > Please select the PayPal payment option and hold off on sending $.

    > We'll email immediately if and when spots open up!

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    Bring your valentines, galentines, and palentines and join us for a scary skate date.

    This year, there's only one shot to win our hearts! The ❤️ Heart Breakers will take on the 🤍 Cupid Crushers in one full-length game.

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    Saturday, February 14

    Rockville Sports Arena
    60 Southlawn Ct., Rockville, MD 20850

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    Event info

    • Registration fee: $15
    • Teams/jersey colors will be assigned by Sunday, February 8.
    • Doors/check-in open at 6 p.m., game starts at 6:30 p.m.
    • Bouts are played by current WFTDA rules and gender policy.
    • Skaters must have WFTDA insurance or equivalent (e.g., USARS).

    Illness safety info

    • If you are experiencing any symptoms, have been exposed, or otherwise suspect you may have any contagious illness, please skip this one. We'll see you next time!
    • Masks are optional, but always welcome. N95 and KN95 masks will be available.
    • FSRD recommends, but does not require, up-to-date COVID vaccinations for skaters, officials, or attendees at public events.

    Any questions? Email FreeStateRollerDerby@gmail.com & FSRD.ILC@gmail.com

  • Waiver

    Medical: The undersigned participant acknowledges that a risk of exposure to covid-19 exists in all public places. It is the responsibility of the undersigned to ensure that they are medically fit to participate in strenuous on-skates activities. As stated below, participation in roller derby activities presents an inherent risk of injury to person or property. The undersigned certifies that they have no known conditions that prohibit or limit participation in any roller derby/skating activities held by or in association with Free State Roller Derby (“FSRD”).

    Additionally, the undersigned must hold WFTDA insurance as well as primary insurance or agree to personally assume all costs to cover any expenses related to injury that may arise from their participation in roller derby with FSRD.

    Equipment and skates: The undersigned must wear the following mandatory safety equipment during all FSRD on-skates activities and practices: knee, elbow, and wrist pads; a certified helmet; and mouth guard. The undersigned must take full responsibility for wearing all aforementioned safety equipment at all times and for wearing it properly. Only quad roller skates are permitted. All skates must be rink-safe, meaning that their use must not gash, indent, or blemish the skating surface or any other surface, and that the skates must not cause injury to property or person(s). All liabilities thereof are undertaken by the undersigned.

    Conduct: Participants must behave in a manner respectful of both person(s) and property. Behavior that could lead, intentionally or unintentionally, to bodily injury or injury to property will not be tolerated.

    In consideration of being allowed to participate in FSRD events, programs, or activities in any way, the undersigned acknowledges, appreciates, and agrees that the risk of injury from the activities is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury remains; and THE UNDERSIGNED KNOWINGLY AND FREELY ASSUMES ALL SUCH RISKS, both known and unknown EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others; and the undersigned assumes full responsibility for their participation; and the undersigned willingly agrees to comply with the stated and customary terms and conditions for participation. 

    If, however, the undersigned observes any unusual, significant hazard during their presence or participation, the undersigned will remove themselves from participation and bring such to the attention of the nearest official immediately; and the undersigned, for themselves and on behalf of their heirs, assignees, personal representatives, and next of kin, HEREBY RELEASES AND HOLDS HARMLESS FSRD, including its coaches, officers, officials, agents, and/or employees; other participants; facilities; and sponsoring agencies, sponsors and advertisers (“releasees”).

    WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss, or damage to person or property, WHETHER ARISING FROM NEGLIGENCE OF THE RELEASEES OR OTHERWISE. I HAVE READ THIS ASSUMPTION OF RISK AGREEMENT, ACKNOWLEDGEMENT AND I ACCEPT RESPONSIBILITY; I FULLY UNDERSTAND ITS TERMS, AND I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

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