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Lesson  Registration & Waiver Form


Participant Information:

Athletes Name: _________________________    Parent Name:________________________

Address: _____________________________   City__________________Zip_____________


Phone: ________________   Parent Cell or Emergency Contact: ______________________


Email Address: ________________________@ ________________


School: _______________________________  Grade in fall: ___ B-day: ______


Height:______Hand:_____   Preferred Position (S/OH/MH/Ds…)____________________


VB Experience: ____________________________________________________________

Type of Clinic/Lessons (Private/Hitters Club…)___________________________________


Amount Due:__________ Check #:_______ Date Paid:_____________


I grant permission for clinic/lesson photos (including my daughter) to be posted on the Illinois Performance Volleyball, Inc. (www.ipvbc.com), Walker Athletic & Sports Performance Complex (www.walkerathletic.com),  or IPV Social Media.


I grant Illinois Performance Volleyball, Inc. (IPV) permission to contact me about future clinics, lessons, volleyball programs and tryouts.


I hereby grant permission for my daughter _______________________________, to attend clinics/lessons offered by Illinois Performance Volleyball, Inc. My daughter has no medical condition that would interfere with her participation in the clinic. I release the clinic/lesson instructors, clinic/lesson facility and all staff from any liability from injuries which may occur.


Parent Signature: _________________________ Date: _________



If, during the course of my daughter’s/son’s activities in volleyball, she should become ill or sustain an injury, I do authorize the Illinois Performance Volleyball, Inc. staff to obtain emergency medical/dental care. I will assume financial responsibility for the bills incurred through my insurance company.


Parent Signature: __________________________ Date: _________



I do not authorize emergency medical/dental car for my daughter/son.


Parent Signature: ________________________ Date: _________

Last Updated on Tuesday, 19 May 2015 16:23