Application Form

* MVRG - - New Hampshire's FIRST Roller Derby League *

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:

Street:

City:

Zip:

Phone Number:

Email Address:

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?

Enter security code:

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.

*** MVRG - - New Hampshire's FIRST Roller Derby League ***

* MVRG - - New Hampshire's FIRST Roller Derby League *