ManchVegasRollerGirls.com - Application Form

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ManchVegas RollerGirls
Application Form

In order to participate in MVRG league practices and/or try-outs, you will need to complete the following steps:

complete the single-page online application form, and

bring a copy of your photo ID and proof of health insurance to practice.

Please Note -- If you do not provide proof of health insurance, you will be required to sign a liability waiver before you can participate in any skating activities.

ManchVegas RollerGirls
Application Form

Name:

Phone Number:

Email Address:

Practice Location:

Skating Experience:

Date of Birth:

Emergency Contact (EC):

EC Phone Number:

EC Relationship:

Do you have insurance?

Insurer Name:

Policy Number:

Have any health issues?

If Yes, please
explain:

Have you ever attended a roller derby bout?

If Yes, please
elaborate:

Have you ever participated in a team sport?

If Yes, please
elaborate:

Occupation:

What talents can you bring to MVRG?

Do you own a business?

If Yes, want to promote it with MVRG?

Why do you want to be a roller girl?

How did you hear about MVRG?

Once your application has been submitted, you will be contacted to schedule your attendance at our next practice. If you're not contacted within 24 hours, please send WESM a reminder email or give her a call at 603-626-5572.