New Skater Waiver Form

This form is for new skaters. Its important that we have this information for your safety and ours. We will only hold this information for as long as reasonably required.

Legal Name

Your email

Phone Number

Date of Birth

Emergency Contact Full Name

Emergency Contact Phone Number

Emergency Contact Relationship to you

Any relevant medical information?

If there is medical information, how can we help you?

Do you agree to the SSRD code of conduct which can be found here?

Do you agree to the media release below?

By consenting to the media release, you consent to photographs and/or videos in which you appear being used by the League without additional consent or communication, on the Sheffield Steel Roller Derby website and social media pages, or in any editorial, promotional or advertising material produced by Sheffield Steel Roller Derby. You understand that this consent can be removed at any time by writing to Sheffield Steel Roller Derby at ssrdcommittee@gmail.com. If you do not consent to the terms of the Media Release, you accept that your name, email address, and skate name and number if applicable will be added to the SSRD Promotional Materials Exclusion list until you give further notice. This information will be shared with relevant league members to ensure your wishes are followed. This information will not be used for any other purpose. Participants involved in any activities offered by Sheffield Steel Roller Derby understand that they may be photographed or videotaped during the session. It is your responsibility to speak to any photographer or videographer present if you wish to minimise the likelihood of your likeness being captured on film. SSRD takes no responsibility for the publication of your likeness on a photographer's or member's personal social media accounts. You accept that such matters should be resolved between the individuals involved.

Do you agree to the waiver the below?

I hereby acknowledge that Roller Derby is a full contact sport which involves certain risks; these are risks which I am willing to take and accept full responsibility for in my participation in roller derby. I declare that I am aware of no physical, medical or other reason why I should not participate in roller skating and roller derby activities. If, at any point, I feel that I am at a high risk of causing injury to myself or other participants then I shall withdraw from activities and inform a coach. I declare that I shall not be under the influence of any substances which may affect my balance and/or judgement on roller skates; nor shall I allow myself to become so affected by any substance at any point throughout my participation in the roller skating activity. I declare that I am over 18 years old. I understand that protective equipment is essential and it is my responsibility to wear it. I understand that in the event of a head injury, I will not be permitted to remain on skates unless cleared by a medical professional. Sheffield Steel Roller Derby will call an ambulance in case of loss of consciousness. I understand that it is my responsibility to ensure my emergency contact details and relevant medical information are up-to-date. I confirm that I will not hold Sheffield Steel Roller Derby liable for, or responsible for, any injuries incurred regardless of cause. I understand that I am taking part in a competitive sporting activity that puts me at risk from actual or attempted physical contact or challenge, intended or unintended. I waive all rights to claim for an injury, consequential losses, equipment damage or other personal loss whilst involved in training sessions with Sheffield Steel Roller Derby Participants involved in any activities offered by Sheffield Steel Roller Derby understand that they may be photographed or videotaped during the session. I acknowledge that it is my explicit responsibility to speak to any photographer or videographer present if I wish to minimise the likelihood of my likeness being captured on film. SSRD takes no responsibility for the publication of a guest's likeness on a photographer's or member's personal social media accounts. I accept that such matters should be resolved between the individuals involved

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