Registration Form

1

Name:* This field is required.

First Name

Last Name

2

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

If you have one to give. Not required!

3

Current interest & skills:Based on this response, we'll place you in the appropriate role.

Know how to skate & am interested in volunteering in assisting as a one-on-one/small group supporter.

Know derby & am interested in volunteering as a guest coach for a specialty clinic.

Know the rules & regulations & am interested in volunteering for lessons & scrimmages as an on skates official.

Know the rules & regulations & am interested in volunteering for lessons & scrimmages, as an off skates official.

Would like to learn the rules & regulations of roller derby.

Want to be of help, off skates, in whatever way I can.

4

E-mail address:* This field is required.A confirmation will be sent to this email.

5

Primary phone number:* This field is required.Can be home or cell. Use what is best.

Area Code

Phone Number

6

Emergency contact name:* This field is required.Someone other than participant, available during class time if needed.

First Name

Last Name

7

Emergency contact phone number:* This field is required.

Area Code

Phone Number

8

Availability:Do sign up for as many dates as you are able to participate. All sessions are held at Magnuson Community Center. Also note, these are our 2019 sessions, and 2020 opportunities are in the works as well.

Sunday, September 22

Sunday, October 13

Sunday, October 27

Sunday, November 10

Sunday, November 24

Sunday, December 8

Sunday, December 22

9

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

10

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!

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