Registration
Prepare for Gotham Girls Roller Derby tryouts by attending this specially scheduled Mini Boot Camp! Review skills that will be evaluated during tryouts such as derby form, stops, skating stance, hitting and receiving hits, falling with control, basic game play and more. Cost: $35 per camp $25 for current Basic Training skaters **All participants must provide their own skates, protective gear (helmet, elbow, knee, wrist pads and mouthguard)
Event:
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Fee per Student: Room:
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Primary Contact Information
First Name:* Last Name: *
Home Phone: Cell #: Work #:
Email: (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Name, Phone & Email*
 
 
Students entered below will be added to your family's account
 
Additional Information:
 
Assumption of Risk
NATURE OF THE ACTIVITY: Gotham Girls Roller Derby, LLC (hereafter referred to as GGRD) is a nonprofit Roller Derby league committed to fostering serious competition for amateur female athletes. Roller Derby involves a competition between two teams, each composed of four blockers and one point scorer who scores by lapping opposing skaters. The benefits are numerous, including the development of athletic ability, cardiovascular fitness, strength, balance, agility, self confidence, sportsmanship, and an exciting competitive opportunity.
INHERENT RISKS: However, while there are many benefits associated with Roller Derby, GGRD feels it is important that the Participant knows that GGRD activities tend to be both vigorous and rough; hence, there are some inherent risks that are always present in an activity like Roller Derby. Roller skating alone has hazards that can result in injury; for instance, falls, hard contact with the floor, collisions with other skaters or with fixed objects. Roller Derby, however, involves all of the risks of roller skating, plus additional risks unique to Roller Derby. Some of these risks include, but are not limited to, blocking a skater, being blocked by other skaters, contact with roller skates while on the floor, skating at high speeds while in close proximity to other skaters, falling on other skaters, being fallen on by other skaters - all of which often result in, or from, falls and collisions. Being tripped, kicked, or struck by forearms, elbows, or helmets is common - even though such actions are against the rules and can result in a penalty.
OTHER RISKS: Other inherent risks include unexpected equipment failure; failure of safety equipment to protect; erratic or careless behavior of the Participant; erratic or careless behavior of other Participants; supervisory or judgment error by GGRD staff, coach, instructor, referee (e.g., coach, instructor, or referee misjudging the capacity of the participant to participate; failure of the referee to see or recognize dangerous actions or situations, failure to spot a hazard during facility inspection).
INJURIES: Participants need to be aware that three types of injury can occur as a result of Roller Derby participation. Most common are minor injuries, which include, but are not limited to, bruises, cuts, scratches, minor sprains, muscle pulls, muscle soreness, and headaches. Occasionally, a participant suffers a major injury, which includes, but is not limited to, eye injuries, broken bones, joint injuries (e.g., fractures, dislocations), internal organ injury, severe sprains, and concussions. And finally, while rare, there is the possibility of a catastrophic injury, which includes, but is not limited to, spinal injuries, injuries resulting in permanent disability, paralysis, heart attack, stroke, brain injury, and death.
ASSUMPTION OF INHERENT RISKS: I, the Participant/Parent Guardian for participants under age 18 , have read the above paragraphs and know that GGRD activities contain inherent risks which are impossible to prevent. I understand the nature and demands of GGRD activities relative to my physical condition and skill level, and I appreciate the types of injuries that may occur as a result of GGRD activities and their potential impact on my/my child's well-being and lifestyle. I hereby assert that my/my child's participation is voluntary and that I knowingly assume all inherent risks.

I've read the above and agree.
 
Release of Liability
Waiver of Liability for Ordinary Negligence:
In consideration of permission to use the GGRD property, facilities, and services, today and on all future dates, I, the Participant/Parent Guardian for participants under age 18, on behalf of myself, my spouse, my heirs, personal representatives, and assigns [hereafter referred to as Releasing Parties] do hereby release, waive, discharge, and covenant not to sue GGRD, its owners, directors, officers, affiliates, employees, volunteers, coaches, instructors, referees, independent contractors, equipment providers, agents co-participants [hereafter referred to as Protected Parties] from liability from any and all claims arising from the ordinary negligence of GGRD or the protected parties.
This agreement applies to 1) personal injury (including death) from incidents or illnesses arising from participation in GGRD activities (including, but not limited to, GGRD league play at the GGRD facility or when competing at other facilities, men's league play, recreation league competition, junior skaters, visiting skaters during practice or scrimmage nights, instruction or classes, observation, individual use of facilities or equipment, shower/locker room area, and all premises including the associated sidewalks and parking lots); and to 2) any and all claims resulting from the damage to, loss of, or theft of property.
Indemnification Agreement: I, the Participant/Parent Guardian for participants under age 18, also agree to hold harmless, defend, and indemnify GGRD and Protected Parties (that is, defend and pay any judgments and costs, including investigation costs, attorney's fees, and related expenses) from any and all claims of Releasing Parties or others acting on my behalf, arising from my/my child's participation in GGRD activities (including those arising from the inherent risks of the activity or the ordinary negligence of Protected Parties). I further agree to hold harmless, defend, and indemnify GGRD and Protected Parties against any and all claims of co-participants, rescuers, and others arising from my/my child's conduct while participating in Roller Derby or while I/my child am on the premises of GGRD.
Clarifying Clauses: I, the Participant/Parent Guardian for participants under age 18, ...
1) Affirm this is the entire agreement between me and GGRD; it can be changed only by written agreement by me and an authorized member of GGRD.
2) I further expressly agree that the foregoing Assumption of Risk, Waiver of Liability, and Indemnification Agreement is intended to be as broad and inclusive as is permitted by the laws of the State of New York and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
3) I also understand that if any legal action is brought, the appropriate trial court for Kings County in the State of New York has the sole and exclusive jurisdiction and that only the substantive laws of the State of New York shall apply.

Participant Agreements, Acknowledgements, and Assertions:
HEALTH I, the Participant/Parent Guardian for participants under age 18, ...
Acknowledge that GGRD urges participants to get medical clearance prior to participation.
Acknowledge that GGRD urges participants to get health and dental insurance prior to participation.
Affirm that I/my child have no health problems that would make participation in GGRD Activities unwise.
Possess a sufficient level of skill and physical fitness for safe participation in GGRD Activities.
Acknowledge that it is my/my child's duty to inform staff and cease exercise immediately in the event of unusual discomfort (e.g., faintness, shortness of breath, high anxiety, chest pains).
SAFETY I, the Participant/Parent Guardian for participants under age 18, ...
Affirm that it is my/my child's duty to cease participation if I feel a hazard or playing conditions are overly perilous.
Have a duty

I've read the above and agree.
 
Photo/Video
Photo/Video Release I, the Participant/Parent Guardian of "Gotham Girls Juniors Derby" participant...
Authorize the use of photos or videos of me in print or electronic marketing, advertising, and web content.

I've read the above and agree.
 
Payment Policies
I give permission to Gotham Girls Roller Derby to automatically deduct the Class fee from the billing information provided for the events I have registered. All payments are non refundable and non transferrable.
I've read the above and agree.
 
WFTDA Waiver
WFTDA RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK,
AND INDEMNITY AGREEMENT
("Agreement")
IN CONSIDERATION of being permitted to participate this date, in any way, at any time, in Women's Flat Track Roller Derby
("Activity"), I, for myself, my personal representatives, assigns, heirs, and next of kin:
1. ACKNOWLEDGE, agree, and represent that I understand the nature of this Activity, and that I am qualified, in good health,
and in proper physical condition to participate in such Activity. I further agree and warrant that if, at any time, I believe the
conditions to be unsafe, I will immediately discontinue further participation in this Activity.
2. FULLY UNDERSTAND that: (a) THIS ACTIVITY INVOLVES RISKS AND DANGERS OF SERIOUS BODILY
INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("Risks"); (b) these Risks and dangers may
be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the conditions in which
the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISKS
or SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT
AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a
result of my participation, in the Activity.
3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the sanctioning organization(s), their
administrators, directors, agents, officers, members, volunteers, and employees, other participants, officials, rescue personnel,
sponsors, advertisers, owners and lessees of Premises on which the Activity is conducted, (each of the forgoing shall be
considered one of the RELEASEES herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON
MY ACCOUNT CAUSED, OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE
RELEASEES OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if,
despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or
anyone on my behalf, makes a claim against any of the RELEASEES, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS
EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may be incurred
as the result of such claim.
I ACKNOWLEDGE THAT I AM OVER THE AGE OF 18 YEARS, HAVE READ THIS AGREEMENT AND FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT,
HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE, AND I
INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST
EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE
INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

I've read the above and agree.
 
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