Crow City Derby Registration Materials, Waivers, Policies, and Info.

www.crowcityderby.com | seretary@crowcityderby.com

Registration Materials:
Registration Form, Assumption of Risk and Indemnity Agreement, Medical Release Form, Member Code of Conduct, and Photo Release Agreement

Fees:
Skaters -
$40 monthly dues: paid to CCD Treasurer.
WFTDA Insurance $80 yearly: paid directly to WFTDA; verification given to the Membership Committee prior to skating at first member practice.

Schedule:
Practices will be every Tuesday and Thursday from 7:00-9:00 pm both at Brown Middle School. These practices are open to all levels. Subject to change, please confirm before attending a practice.
We will periodically be holding 101 classes specifically for beginners. Please reach out to find out when our next program will launch.

WFTDA Membership:
All CCD skaters are required to purchase WFTDA insurance directly from WFTDA.

Medical Insurance:
There are inherent risks that can lead to injury when playing roller derby and participating in CCD practices, scrimmages and bouts. Each participant is HIGHLY encouraged to carry personal medical and accident insurance as this sport can cause significant injury with very large expenses. CCD does not provide medical insurance for CCD skaters or participants.

Equipment:
Properly fitting protective gear must be worn at all times while on skates. The following is required and you will be unable to skate without the following:

● Helmet ‐ Skateboard or hockey type is acceptable.
● Protective Gear ‐ Wrist guards, elbow and knee pads.
● Mouth Guard ‐ Football standard mouth guard is recommended. Many of our skaters use SISU brand.
● Quad Skates ‐ Skates should be comfortable and well built. Properly fitting skate boots reduce the risk of injury.
o Wheels with a hardness rating of 88‐92 are recommended. Most quad derby skates use 8mm bearings.
● Tail‐bone protectors or butt pads are recommended.

Flight School:
New skaters are STRONGLY encouraged to attend 101 with CCD, but another option is Derby 101 class at RCR and/or Intro to Roller Derby at Oaks Park Roller Skating Rink to build basic derby skills. You are welcome to attend a derby 101 class, but can also learn basic skills at our regular practices.

Local Retail options:
Five Stride Skate Shop and Oaks Park Skate Shop are both great local options with knowledgable staff. There are a variety of other sporting goods stores where helmets and mouth guards can be found.

Online Retail options:
There are a variety of Roller Derby gear websites. Derbywarehouse.com is a great online resource and we have a discount code with them (Ask any member for the code). The staff at all of these places are very helpful and are available by phone to answer gear questions. You can often purchase “Fresh Meat” packages either in retail stores OR online to save some money and get you started.

League Code of Conduct:
The code of conduct for league members and affiliates is in place to preserve the spirit of the sport of roller derby and to uphold a professional and positive environment. All league members and affiliates are always expected to conduct themselves respectfully and professionally toward fellow league members and affiliates. League members and affiliates are responsible for holding themselves accountable and are solely responsible for their own behavior. Crow City Derby league members and affiliates are prohibited from behaving towards any member or affiliate of the roller derby community in a way that could be considered discriminatory or demeaning, including intimidation, verbal abuse or harassment, sexual harassment or assault, and/or physical violence beyond the normal scope of game play. This applies not only to fellow league members and affiliates but extends to fans, volunteers, coaches, skating/non-skating officials, and members of other leagues. League members and affiliates are to represent the sport of roller derby in a positive manner that will not discredit teammates, other league members and affiliates, or jeopardize inter-league relations.

All Crow City Derby members and affiliates must respect the safety of fellow skaters and themselves and respect the mission and core values of Crow City Derby. Included in this is any use of drugs, alcohol, or tobacco that can endanger spectators, fellow teammates, opposing skaters, or the skater themselves. League members and affiliates are representatives of Crow City Derby and are prohibited to participate in any illegal activity during practice, bouts, or any league sponsored activities. The code of conduct also prohibits all behavior that can or may be considered discriminatory based on age, race, religion, gender, national origin, or sexual orientation.

Outside of league activities, members are prohibited to express league business on social media networks, the press, or media in any negative context. While speaking about league business on a public forum, the league must be represented in a positive and productive manner.

Repeated or egregious violation of the Crow City Derby Code of Conduct may result in disciplinary measures being enacted which include but are not limited to single or multi-game suspension, skating suspension not to exceed 30 days, and/or termination of an individual’s membership or affiliation.

Acknowledgment and Agreement for Crow City Derby Code of Conduct:
By participating in Crow City Derby, you acknowledge and agree to adhere to the policies and procedures outlined in the membership document, the league’s official bylaws, and all other policies and procedures set forth by the league. Individual membership/affiliation is conditional upon adherence to these rules and the code of conduct; failure to comply may result in termination of membership. The materials contained in the Crow City Derby membership document, league bylaws and all other policies and procedures are for your use and reference, however such materials are subject to change. You may contact the Board of Directors regarding any updates or changes to such materials, including any amendments to league policies or bylaws.

(Please sign with your electronic signature in form below)

Photo Release Agreement:
For consideration which I acknowledge, I irrevocably grant to Crow City Derby (CCD), and CCD assigns, licensees, and successors the right to use my image and name in all forms and media including composite or modified representations for all purposes, including advertising, trade or any commercial purpose throughout the world and in perpetuity. I waive the right to inspect or approve versions of my image used for publication or the written copy that may be used in connection with the images.

I relinquish any right that I may have to examine or approve the completed product or products or the advertising copy or printed material that may be used in conjunction therewith or the use to which it may be applied.
I release CCD and CCD assigns, licensees and successors from any claims that may arise regarding the use of my image including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright.
CCD is permitted, although not obligated, to include my name as a credit in connection with the image.
CCD is not obligated to utilize any of the rights granted in the Agreement.
I have read and understood the photo release agreement.

(Please sign with your electronic signature in form below)

Participant's Name

First Name

Last Name

Date of Birth

Preferred Pronouns

Participant's Skate Name (If you have one)

Skater Number (If you have one)

(Will check to make sure preferred number is not already in use)

Full Address (include state, city, and zip code)

Phone

WFTDA Policy Number

Previous League Affiliation

Insurance Provider

Insurance Policy Number

Emergency Contact

Please provide name, relationship, and phone number/s

Alternate Emergency Contact

Please provide name, relationship and phone number/s

Optional:

Primary Care Physician: Primary Care Physician Phone: Insurance Provider: Policy Number: Emergency Care Facility of Choice (In case of emergency): Hospital of Choice (In case of emergency): Dentist Name: Dentist Phone:

Medical, Equipment, and Conduct Acknowledgement/Agreement

Medical: It is the responsibility of the undersigned (the Participant) to ensure that they are medically fit to participate in strenuous on-rink, or off-rink activities. As stated below, participation in roller derby activities presents an inherent risk of injury to person or property. The undersigned certifies that the above-named Participant has no known conditions that prohibit, or limit participation in any roller derby, or roller skating activities, including off-rink activities (the “Roller Derby Activities”) held by or in association with the Crow City Derby. Additionally, CCD recommends that the undersigned be covered by primary medical insurance at all times for the participant to cover any expenses related to any potential injury that may arise from their participation in the Roller Derby Activities. Skating Equipment: The undersigned must take full responsibility that the above named Participant properly wears the following recommended safety equipment during all Roller Derby Activities: Mouth Guard, Knee Pads, Elbow Pads, Wrist Guards, and Helmet. Eyeglasses must have plastic shatterproof lenses. Only four-wheeled roller skates are permitted. Participants should use the softest wheel composition available to achieve the best possible grip on the skating surface. All roller skates must be rink-safe, meaning that their use must not gash, indent or blemish the skating surface or cause property damage. All equipment liabilities thereof are undertaken by the undersigned. Conduct: Participants signing this waiver must behave in a respectful manner to both person and property during Roller Derby Activities. Behavior, which could potentially lead to intentional or unintentional bodily injury or damage to property, will not be tolerated and questionable behaviors will be reviewed by CCD. If the behavior is found unacceptable, this may result in a participant’s expulsion from the premises and all Roller Derby Activities. Please electronically "sign" below:

Indemnification and Risk Acknowledgement:/Agreement

In consideration of being allowed to participate in any way in the Roller Derby Activities, the undersigned acknowledges and agrees that: 1. The risk of injuries from Roller Derby Activities is significant, including the potential for permanent paralysis and death and while particular rules, equipment and personal discipline may reduce this risk, the risk of injury remains 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF CCD or its individual members (the “Releasees”) and I assume full responsibility for my participation 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of CCD immediately 4. I for myself and on the behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the Releasees with respect to any and all injury, disability, death, loss, or damage to my person or property. Please electronically "sign" below:

Statement of Consent

In the event of an emergency or non‐emergency situation requiring medical treatment, I hereby grant permission for any and all medical and/or dental attention to be administered to me, in the event of an accidental injury or illness, until such time as I am able to make responsible medical decisions for myself and/or one of my emergency contacts can be reached. This permission includes, but is not limited to, the administration of first aid, the use of ambulance, and the administration of anesthesia and/or surgery, under the recommendation of qualified medical personnel. Representatives, employees, agents, and volunteers of Crow City Derby are granted permission to seek such medical treatment, and I hereby agree to indemnify, defend and hold such persons harmless for any actions taken by such persons in reliance upon the Medical Release or any care rendered in reliance upon this Medical Release. Please electronically "sign" below:

Code of Conduct Agreement:

I have read, understood and agree to the Crow City Derby Code of Conduct in the text above. Please electronically "sign" below

Photo Release Agreement:

I have read and understood the photo realease text above. Please electronically "sign" below

Terms Agreement

I AM 18 YEARS OF AGE OR OLDER, HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE, ORAL OR WRITTEN, AND INTEND THIS AGREEMENT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. I AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. Please electronically "sign" below: