Clinic/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:_____________
 

Waiver:

I grant permission for clinic/lesson photos (including my daughter) to be posted on the Illinois Performance Volleyball, Inc. (www.ipvbc.com), Elite Sports Complex (www.elitesportscomplex.com), Walker Athletic & Sports Performance Complex (www.walkerathletic.com), Team Connection (www.teamconnection.com), TribLocal (www.triblocal.com) or similar websites and/or in area newspaper articles.

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: _________