UBI 603 039 258 HeadHigh Program 501 (c) (3)

seattle JUNIOR

ROLLER DERBY

It's cool to be strong!

You can STILL be on a team and have some fun playing team games.

It can be fun to play games on teams!

bully free zone!

seattle Junior Roller Derby

Your Name *

First Name

Middle

Last name

Parent or Guardian

Email *

Child's Name *

First Name

Middle

Last name

Phone

area code + 7 digit phone number

Include if you'd like us to call you!

Anything you'd like us to know about your child?

Age *

6-8
8-11
12+

Skill Level *

Beginner
Some skating experience
Has skated derby

Anything you'd like to add?

Go ahead SAY it! We want to know!