T EXAS R OLLERGIRLS J UNIOR L EAGUE

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1 2010 SPRING SESSION REGISTRATION Texas Rollergirls Rock-n-Rollerderby proudly presents the Texas Rollergirls Junior League, aka the Austin Derby Brats. This junior flat track derby program, open to girls ages 8 to 17, represents the future of women s roller derby. The Texas Rollergirls are excited to train the next generation of roller derby athletes! The primary focus of the Texas Rollergirls Junior League program is to develop character, confidence, leadership and social interaction in girls through sports, and the Austin Derby Brats believe that performance is secondary to these ideals. The Austin Derby Brats intends to nurture and develop both skilled athletes and those who have not yet realized the champion inside of them. We subscribe to the following governing principles: 1. Safety 2. Good sportswomanship 3. Full participation (everyone gets to play!) Age Groups & Requirements Skaters are required to be 8 years or older on or before the first week of the 12-week session to be eligible to skate with the Texas Rollergirls Junior League. During some practice activities, skaters are grouped by age to ensure that skaters of similar size and strength practice together. Depending upon the circumstances, changes may be made to the age groups. For example, skaters who are young for their grade level or who are small for their age could be placed in different age groups. Elementary school (ages 8-10) Middle School (ages 11-13) High School (ages 14-17) Practice, Scrimmage & Orientation Information Skaters must wear all protective equipment when participating in practices and scrimmages (knee and elbow pads, wristguards, helmet, and mouthguard). The registration fee covers the 12-week session that starts on February 11, 2010 and ends May 13, 2010 (there will be no practices during Spring Break (March 18) and TAKS testing (April 29)). Practices: o Roller derby skills: Thursdays from 7 to 8pm at the Millennium Youth Entertainment Complex (MYEC; 1156 Hargrave St.) o Speed skating skills: Fridays from 6 to 7pm at Playland Skate Center (8822 McCann Dr.) Scrimmages will be held from 7 to 8pm at MYEC on: o April 1, 2010 o April 22, 2010 o May 13, 2010 o One hour of open skate with Big Sisters from both Austin women s roller derby leagues before each scrimmage Parent, skater, and manager orientation on Thursday, February 4, 2010, from 7 to 8 pm at MYEC skating rink Registration Fee and Insurance Coverage Registration fee for each skater is $ The cost of equipment is not included in the registration fee. There are no refunds. Registration deadline is the 4 th practice on March 4, Registration fee may be waived if selected for the Texas Rollergirls Junior League Scholarship. Each skater is encouraged strongly to have primary insurance. The Texas Rollergirls Junior League/Austin Derby Brats are members of USA Rollersports (USARS; Each skater is encouraged to become an individual member of USARS. Individual membership costs $40.00 per year and provides excess (secondary) accident/medical insurance benefits. Texas Rollergirls, all rights reserved. Texas Rollergirls is a registered trademark of the Texas Rollergirls Inc. Page 1 of 4

2 Required Equipment Helmet Pads wrist guards, elbow and knee pads Mouth guard (football standard) Quad roller skates (no inlines) Reusable water bottle REGISTRATION INFORMATION (continued) Helmet, pads, and mouth guard can be purchased at any sporting good store. Please make sure the equipment fits correctly. Feel free to the Junior League manager for more information and recommendations on purchasing your skates and gear. Texas Rollergirls Junior League Management Information Management of the Texas Rollergirls Junior League will consist of three managers. The for all managers is The 2010 managers are: Name Skate Name Position Phone Lisa Benson DeBella DeBall Manager Brittany Bodine Mary Lou Threaten Head Trainer Jennifer Wilson Hydra Program Coordinator If you have any questions and or would like more details, please contact any of the Junior League managers. Thank you for your interest in the Austin Derby Brats! Playland Skate Center Millennium Youth Entertainment Complex 8822 McCann Dr Hargrave St. Austin, TX, Austin, TX, Texas Rollergirls, all rights reserved. Texas Rollergirls is a registered trademark of the Texas Rollergirls Inc Page 2 of 5

3 REGISTRATION FORM SKATER LEGAL NAME: SKATE NAME (optional): DATE OF BIRTH: SCHOOL: GRADE LEVEL: HOME ADDRESS: PARENT/LEGAL GUARDIAN NAME: PHONE NUMBER: EMERGENCY CONTACT: PHONE NUMBER: RELATION: Skaters must pay at time of registration. Registration deadline is March 4, Payment Information: $ cash, check (payable to Texas Rollergirls, Inc.), or Paypal via the website ( is due on or before the 4 th practice (March 4, 2010). This payment is non-refundable. Individual membership in USA Rollersports encouraged. Information below is to be used by Texas Rollergirls, Inc., managers Payment Method: Cash Check Charge Paid in Full Date: Installment Plan: Yes / No Payment Date(s):_ TXRG Approval:_ Texas Rollergirls, all rights reserved. Texas Rollergirls is a registered trademark of the Texas Rollergirls Inc Page 3 of 5

4 PARENTAL AUTHORIZATION / MEDICAL RELEASE I, parent or legal guardian, of (Skater s Legal Name) hereby give authorization for participation in any and all Texas Rollergirls Junior League activities. I hereby grant permission to managing personnel and league representatives to authorize and obtain medical care from any licensed physician, hospital or medical clinic, should the skater become ill or injured while participating in league activities when neither parent nor legal guardian is present to grant authorization for immediate treatment. I assume all risks and hazards incidental to such participation, including transportation to and from league activities, and do hereby waive, release, indemnify and agree to hold harmless Texas Rollergirls Junior League and its agents, assigns, representatives, officers and employees from any and all claims arising out of the skater s participation in any and all league activities. I HAVE READ AND UNDERSTAND THE ABOVE REGISTRATION FORM AND PARENTAL AUTHORIZATION / MEDICAL RELEASE. I VERIFY THAT I HAVE COMPLETED THIS FORM AND THAT THE INFORMATION I PROVIDED IS TRUE AND CORRECT. I FURTHER AGREE TO ABIDE BY THE RULES/GUIDELINES SET FORTH BY TEXAS ROLLERGIRLS JUNIOR LEAGUE. Signature of Parent / Legal Guardian Date Relationship to Skater PLEASE LIST BELOW ANY MEDICAL INFORMATION OR CONDITION WHICH MAY BE RELEVANT TO THE CARE AND TREATMENT (EMERGENCY OR OTHERWISE) OF THE CHILD NON-COMPETE CLAUSE While participating as an individual member of the Texas Rollergirls Junior League aka Austin Derby Brats, a member may not participate with another roller derby league. Each individual member of the Texas Rollergirls Junior League will agree to not be a member of or train or compete on a team with another roller derby league while skating as an Austin Derby Brat unless given written authorization from the Texas Rollergirls Junior League managers. Signature of Skater: Date: Signature of Parent/Legal Guardian: Date: _ Staff Initials: Texas Rollergirls, all rights reserved. Texas Rollergirls is a registered trademark of the Texas Rollergirls Inc Page 4 of 5

5 MEDIA RELEASE AGREEMENT For consideration which I acknowledge, I irrevocably grant to Texas Rollergirls, Inc., ("Company") and Company's assigns, licensees and successors the right to use my image and (skater) 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 Company and Company's 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. Company is permitted, although not obligated, to include my name as a credit in connection with the image. Company is not obligated to utilize any of the rights granted in this Agreement. I have read and understood the media release agreement. Signature of Skater: Date: Signature of Parent/Legal Guardian: Date: _ Staff Initials: Texas Rollergirls, all rights reserved. Texas Rollergirls is a registered trademark of the Texas Rollergirls Inc Page 5 of 5