Registration Form

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Complete the following form to register up to 5 youth to participate in PFM Juniors. We will ask for name, age, current skating skill level, parent/guardian name and contact information, and an emergency contact if needed. Though not required, pre-registration does help our planning.

Also note, to register more than 5 youth will require another form.

Are you an adult interested in learning to skate? Contact pfmrollerderby@gmail.com to learn more!

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Number of youth participants to register:* This field is required.You may register up to 5 youth on this form.

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Youth participant #1:* This field is required.

First Name

Last Name

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Skater name:If you have one to share, add that here. Not required!

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Current age:* This field is required.PFM Juniors is designed for ages 5 to 17.

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Current Skating Skills:* This field is required.Select the one description that fits best. Based on the selection, we'll place the participant in the appropriate spot. This is not a fixed assignment, and skaters may move between Level 1 beginner and Level 2 intermediate throughout the program.

Little to no skating experience (Level 1).

Can skate forward & stop, new to derby or just attended my first junior derby class or camp (Level 1).

Can stop, turn around & skate backwards. Have not played junior derby (Level 1-2).

Have played derby on a Level 2 juniors team (Level 2).

Have played derby & am interested in volunteering to be a peer mentor to new skaters.

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Youth participant #2:

First Name

Last Name

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Skater name:If you have one to share, add that here. Not required!

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Current age:* This field is required.PFM Juniors is designed for ages 5 to 17.

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Current Skating Skills:* This field is required.Select the one description that fits best. Based on the selection, we'll place the participant in the appropriate spot. This is not a fixed assignment, and skaters may move between Level 1 beginner and Level 2 intermediate throughout the program.

Little to no skating experience (Level 1).

Can skate forward & stop, new to derby or just attended my first junior derby class or camp (Level 1).

Can stop, turn around & skate backwards. Have not played junior derby (Level 1-2).

Have played derby on a Level 2 juniors team (Level 2).

Have played derby & am interested in volunteering to be a peer mentor to new skaters.

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Youth participant #3:

First Name

Last Name

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Skater name:If you have one to share, add that here. Not required!

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Current age:* This field is required.PFM Juniors is designed for ages 5 to 17.

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Current Skating Skills:* This field is required.Select the one description that fits best. Based on the selection, we'll place the participant in the appropriate spot. This is not a fixed assignment, and skaters may move between Level 1 beginner and Level 2 intermediate throughout the program.

Little to no skating experience (Level 1).

Can skate forward & stop, new to derby or just attended my first junior derby class or camp (Level 1).

Can stop, turn around & skate backwards. Have not played junior derby (Level 1-2).

Have played derby on a Level 2 juniors team (Level 2).

Have played derby & am interested in volunteering to be a peer mentor to new skaters.

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Youth participant #4:

First Name

Last Name

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Skater name:If you have one to share, add that here. Not required!

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Current age:* This field is required.PFM Juniors is designed for ages 5 to 17.

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Current Skating Skills:* This field is required.Select the one description that fits best. Based on the selection, we'll place the participant in the appropriate spot. This is not a fixed assignment, and skaters may move between Level 1 beginner and Level 2 intermediate throughout the program.

Little to no skating experience (Level 1).

Can skate forward & stop, new to derby or just attended my first junior derby class or camp (Level 1).

Can stop, turn around & skate backwards. Have not played junior derby (Level 1-2).

Have played derby on a Level 2 juniors team (Level 2).

Have played derby & am interested in volunteering to be a peer mentor to new skaters.

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Youth participant #5:

First Name

Last Name

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Skater name:If you have one to share, add that here. Not required!

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Current age:* This field is required.PFM Juniors is designed for ages 5 to 17.

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Current Skating Skills:* This field is required.Select the one description that fits best. Based on the selection, we'll place the participant in the appropriate spot. This is not a fixed assignment, and skaters may move between Level 1 beginner and Level 2 intermediate throughout the program.

Little to no skating experience (Level 1).

Can skate forward & stop, new to derby or just attended my first junior derby class or camp (Level 1).

Can stop, turn around & skate backwards. Have not played junior derby (Level 1-2).

Have played derby on a Level 2 juniors team (Level 2).

Have played derby & am interested in volunteering to be a peer mentor to new skaters.

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Parent/guardian name: * This field is required.

First Name

Last Name

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Parent/guardian e-mail address:* This field is required.A confirmation will be sent to this email.

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Parent/guardian primary phone number:* This field is required.Can be home or cell. Use what is best.

Area Code

Phone Number

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Emergency contact name:* This field is required.Someone other than the parent/guardian given, available during session times, and only contacted if parent/guardian is not reached first.

First Name

Last Name

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Emergency contact phone number:* This field is required.

Area Code

Phone Number

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Additional comments:Anything we should know? Add that here.

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Do know that prior to attendance to PFM juniors, a release of liability and photo release form is required. Peer & adult mentors will also be required to compete a volunteer background check. Thank you for your interest in PFM Juniors! We'll be in touch!