Your Name:

Your Email:

Your Phone Number:

Are you 21 or older?
yes no
Your Date of Birth:

Are you physically a female?
yes no
Do you have health insurance?
yes no
Are you in moderate to good physical condition?
yes no
Do you have moderate to good skating ability?
yes no
Are you able to purchase your own equipment?
yes no
Are you able to attend practices at least 2 times a week, more if necessary?
yes no
Are you willing to be physical and risk getting hurt for the sport?
yes no

How much do you know about roller derby?
Everything! I watch other leagues bout all the time, I know all the rules.
Very Familiar. I've been to some bouts.
A Fair Amount. I've read about it and seen some footage.
Very Little. I've read some blurbs.
Nothing

How did you hear about us?

Why do you want to be a rollergirl?