Registration
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Come skate for Gotham Roller Derby! Tryouts will be held at Lakeside Rink in Prospect Park Brooklyn on Monday, October 21st from 6:30pm to 8:15pm. Call backs will be on Wednesday, October 23rd from 6:30pm to 8:15pm. All participants must be 18 years of age. Every skater is required to wear a helmet, wrist guards, elbow pads, knee pads, a mouth guard and quad roller skates. Tryout fees are put towards the cost of rink rental.
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Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
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Skater Email (if different from above):
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Disabilities:
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Student's First Name:
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Student's First Name:
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Skater Email (if different from above):
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Disabilities:
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Student's First Name:
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Skater Email (if different from above):
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Disabilities:
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Allergies:
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Primary Doctor:
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Most recent session attended?:
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WFTDA insurance # (18+):
Add New Student #5:
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Student's First Name:
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Last Name:
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Birth Date:
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Skater Email (if different from above):
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Disabilities:
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Allergies:
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Medications:
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Primary Doctor:
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Most recent session attended?:
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WFTDA insurance # (18+):
Questions/Options:
How often do you currently skate?
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If you currently skate, what kind of skating do you do? (i.e. park, speed, street, jam, derby, etc.)
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Have you attended any of Gotham's Basic Training sessions? If yes, when and what levels?
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Describe any previous skating experience. Please add specific dates or length of time if applicable:
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Describe your previous athletic experience (please include specific dates or length of time):
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Please describe any non-skating movement/workout routine you currently have (e.g. crossfit, yoga, other sports, etc).
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GRD skaters have a minimum monthly attendance requirement of 10 hours, along with committee hours and events. Is that time commitment possible for you?
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Gotham is run by its volunteers. What off-track skills would you bring to the league?
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Do you have previous experience as a member of another roller derby league? Please provide the names of your former league(s) and date(s) of membership.
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If you answered yes to question 9, how many interleague and intraleague games have you played?
If you answered yes to question 9, what position did you play? What was the league's monthly practice requirement? What was the average number of practices you attended/hours you practiced per month?
If you answered yes to question 9, what committees did you serve on? Did you hold any board positions?
Do you have any questions for Gotham?
Additional Information:
Assumption of Risk
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NATURE OF THE ACTIVITY: Gotham Girls Roller Derby NFP dba Gotham Roller Derby (hereafter referred to as Gotham) is a nonprofit Roller Derby league committed to fostering serious competition for amateur 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, Gotham feels it is important that the Participant knows that Gotham 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 Gotham 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 Gotham Roller Derby activities contain inherent risks which are impossible to prevent. I understand the nature and demands of Gotham activities relative to my physical condition and skill level, and I appreciate the types of injuries that may occur as a result of Gotham 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
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Waiver of Liability for Ordinary Negligence:
In consideration of permission to use the Gotham 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 Gotham, 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 Gotham or the protected parties.
This agreement applies to
1) personal injury (including death) from incidents or illnesses arising from participation in GRD activities (including, but not limited to, GRD 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, virtual 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.
I've read the above and agree.
Indemnification/Health/Photo Release Agreement
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Indemnification Agreement:
I, the Participant/Parent or Guardian of Participant, also agree to hold harmless, defend, and indemnify Gotham 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 participation in Gotham 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 Gotham and Protected Parties against any and all claims of co-participants, rescuers, and others arising from my conduct while participating in Roller Derby or while I am on the premises of Gotham.
Clarifying Clauses: I, the Participant/Parent or Guardian of Participant...
1) Affirm this is the entire agreement between me and Gotham; it can be changed only by written agreement by me and an authorized member of Gotham.
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.
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Participant Agreements, Acknowledgements, and Assertions:
Health I, the Participant/ the Participant/Parent or Guardian of Participant..., ...
Acknowledge that Gotham urges participants to get medical clearance prior to participation.
Acknowledge that Gotham urges participants to get health and dental insurance prior to participation.
Affirm that I have no health problems that would make participation in Gotham Activities unwise. Possess a sufficient level of skill and physical fitness for safe participation in Gotham Activities. Acknowledge that it is my 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 Participan/ I, the Participant/Parent or Guardian of Participant..., ...
Affirm that it is my duty to cease participation if I feel a hazard or playing conditions are overly perilous. Have a duty to immediately report or correct any unsafe hazard or dangerous behavior.
Acknowledge that Gotham urges all participants wear safety equipment at all times during participation or practice.
Will inspect the facilities and equipment and participate only if I feel they are sufficiently safe.
Agree to abide by all policies, rules, and regulations of Gotham. Injury I, the Participant/ I, the Participant/Parent or Guardian of Participant..., ...
Understand that I have the ultimate duty to determine the nature of an injury and decide whether to continue.
Agree to report all injuries, minor or more serious ones, to Gotham before leaving the facility.
Authorize Gotham to render emergency first aid or CPR and secure emergency medical care or transportation (i.e., EMS) when deemed necessary by Gotham; and I agree to assume all costs of emergency medical care and transportation.
Photo/Video Release
I, the Participant/ I, the Participant/Parent or Guardian of 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
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I give permission to Gotham Roller Derby to automatically deduct the Class fee from the billing information provided for the events I have registered. I understand that ALL PAYMENTS ARE NON-REFUNDABLE AND NON-TRANSFERABLE
I've read the above and agree.
WFTDA Waiver
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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 Flat Track Roller Derby or Banked 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 Women's Flat Track Derby Association (WFTDA), the league(s), 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.
Lakeside Waiver Part 1
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ssumption of Risk. Each Participant and/or Participant’s parent(s) or guardian(s) (individually and collectively, “Participant” or “You”) understands, acknowledges, and agrees that ice skating, ice hockey, roller skating, and other recreational activities and sports offered at the LeFrak Center at Lakeside are inherently dangerous and physically demanding activities that may result in bodily injury, death or property damage (individually and collectively “Injury”).
Risks of ice skating, ice hockey, roller skating, curling, and other recreational activities and sports include, but are not limited to, the condition of the ice and/or rink, and variations in the rink surface and subsurface (such as wetness, slush or other variations), whether they are caused naturally or are man-made, and whether resulting from activities of the skating rink operator or other persons or equipment; weather conditions and the impact of variable weather; natural objects or man-made objects that are incidental to the provision or maintenance of an ice skating rink; the design, construction, operation, inspection, supervision, control and/or maintenance of the facilities; hiring, training and/or supervision of employees; entering and exiting the rink; the skates and other skating equipment selected and/or worn by the Participant; collisions, near misses, and other persons using the facilities; risks associated with skating instruction, if applicable; and all risks of skating in an outdoor public park. Participant voluntarily and expressly assumes the inherent and other risks of Injury arising from or related to use of the facilities and/or equipment, and/or engaging in ice skating, ice hockey, roller skating and any other activity at the LeFrak Center at Lakeside and at all related facilities and surrounding areas (collectively “Lakeside”), whether or not the Injury arises while actively participating in the sports of ice skating, ice hockey, curling or roller skating. All of the inherent and other risks of ice skating, ice hockey, curling or roller skating (and skating instruction if applicable) present the risk of Injury.
In addition, beginner skaters almost by definition are unable to skate under control to the extent that more experienced skaters are, and any skaters, including beginner skaters (whether or not taking instruction), may pose risks to themselves and other users of the facilities. These risks and dangers include, but are not limited to, risks arising from developing skills and experience, and/or participating with bigger, faster and stronger participants or with those of less experience. These risks and dangers may increase if Participant participates in ice hockey, ice skating, and other similar member team activities and instructional clinics and classes in an age or skill group above or below Participant’s age or skill level. The undersigned further acknowledge that there may be risks and dangers not known or not reasonably foreseeable at this time.
Participant agrees to abide by the “Code of Skater Responsibility” and to follow the instructions of the staff of Lakeside. If You are skating aggressively, power stopping, or skating in any manner that endangers fellow skaters or other users of the facilities, You may be warned and/or asked to leave the rink. We reserve the right to permanently ban aggressive skaters. However, it remains the responsibility of each Participant to be aware of prevailing conditions and the behavior of other participants, and to decide whether to skate in light of the potential risks they pose. Parents/guardians and/or group leaders are responsible for supervising and monitoring minors, guests and any other Participants they bring to Lakeside. It is up to the discretion of the Parent/Guardian to determine if a minor may skate without an accompanying adult.
Waiver and Release of Claims. To the fullest extent permitted by law, Participant waives and releases any and all claims arising from or re
I've read the above and agree.
Lakeside Waiver Part 2
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Miscellaneous/Governing Law/Forum Selection. (a) This Agreement shall be governed by the substantive laws of the State of New York without regard to conflict of laws principles; (b) all disputes arising from or related to this Agreement, this Agreement, any Injury, Participant’s use of the premises and/or equipment at Lakeside, rental of skates, participation in any classes or instruction and/or from any cause whatsoever, shall be litigated exclusively in the Supreme Court of the State of New York, County of New York or in the United States District Court for the Southern District of New York; (c) In the event any provision of this Agreement shall be deemed unenforceable, all other provisions shall remain valid and enforceable; (d) Participant understands that Lakeside is open to the public and agrees that members of the public may photograph or otherwise record, in any manner, Participant and any activities there. Participant also understands that the facility is monitored by video surveillance. If Participant does not want to be photographed or recorded, Participant agrees not use the facilities. Participant further permits UV, Lakeside, PPA, Sponsors, the City, the Parks Department and their licensees, designees, successors and assigns (“Users”), to make and use any photographs, videotapes, sound recordings, or any other records taken while on the premises of Lakeside for publicity, advertising, or any other purpose. Users have a worldwide, perpetual, irrevocable, fully-paid, royalty-free, transferable and sublicenseable right and license to use, copy and disseminate Participant's image and personal attributes, and to modify and present same in any form, manner and media, now known or hereafter devised; (e) If a minor requires emergency medical attention, Lakeside may provide or secure treatment but Lakeside has no responsibility to administer any medication to any minor; (f) The undersigned acknowledges that s/he has not relied upon any representations of Releasees or Indemnitees; that s/he is fully advised of the potential dangers involved; and understands that this Agreement is necessary for Participant to engage in recreational activities (and if applicable, in camp and/or instructional activities, clinics, classes, events and member team activities) at Lakeside.
I have read, fully understand, and agree to the provisions of the above-referenced LeFrak Center at Lakeside ACKNOWLEDGMENT OF RISK, RELEASE OF LIABILITY, INDEMNIFICATION, AUTHORIZATION FOR MEDICAL TREATMENT AND FORUM SELECTION AGREEMENT. I UNDERSTAND THAT THIS IS A LEGAL DOCUMENT AND THAT BY SIGNING THIS CONTRACT I AM ASSUMING CERTAIN LEGAL RIGHTS AND MAY BE WAIVING OTHERS.
I've read the above and agree.
Gotham Code of Conduct
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I pledge to uphold this Gotham Code of Conduct, which offers a general guide to my conduct with Gotham Roller Derby. I recognize that this code does not establish a complete set of rules that prescribe every aspect of appropriate behavior but acts a guideline for our values and the structure for accessing help, and creates a plan for instances of misbehavior.
As a Member, the parent/guardian of a member, staff, volunteer, participant, or visitor of GRD I pledge to:
Act in a way that will bring respect and honor to myself, GRD, and the sport of roller derby and support GRD’s mission of fostering inclusive, high-level sports.
Respect members of my team, other teams, spectators, officials, volunteers, staff, and engage in no form of verbal, physical, or sexual harassment, discrimination, bullying or abuse.
Take personal responsibility for my actions both on and off the track while representing GRD.
Make practices, scrimmages, bouts, clinics, camps and all GRD events safe and inclusive for all.
Read and uphold the GRD Rules, GRD ByLaws, this Code of Conduct and all other required agreements.
Support and uphold these values and my fellows by truthfully reporting violations if I encounter them.
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Any violation of these tenets or any form of harassment will be met with disciplinary action as stipulated in the GRD Handbook (section 20.0 Disciplinary Action and section 27.0 Whistleblower Policy). Any report of physical or sexual harassment or abuse will automatically result in proceedings for league dismissal (section 21.1 Grounds for Dismissal from the League).
I agree to abide by and be bound by this GRD Code of Conduct, and policies and procedures authorized by GRD as they may be amended from time to time.
I've read the above and agree.
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