Participants Name : __________________ _____________________________ Circle: M F
(First) (Last)
School: _________________________________ Grade Next Fall: _________ DOB _____/_____/______
School Experience - Yrs: _____ Team(Var,JV,etc.): ____________ Club Experience - Yrs: _____ Position: __________
Participant's Address: _______________________________ City, State, & Zip Code: ________________________________
Participant's Phone Number: (______) ______-________ Cell: (______)______-________ E-Mail: _______________________________
Parent / Guardian: ___________________________________________
Parent's Address(If different): _________________________ City, State, & Zip Code: ________________________________
Parent's Phone Number- Home:(______)______-________ Mom Cell:(______)______-________E-Mail: _________________________
Dad Cell:(______)______-________ Other:(______)______-________E-Mail: _________________________
RELEASE AND HOLD HARMLESS AGREEMENT / AUTHORIZATION FOR TREATMENT OF A MINOR: In consideration of participation in the 2011 and 2012
Collegiate Beach Volleyball Training Program activities (“activities”), including but not limited to clinics, workouts, practices, beach tournaments, other tournaments,
competition, field trips and other activities, and with complete understanding said participant shall or may take a physical test of volleyball skills, I (we) understand and
agree to the following:
______________________________________________, participant is hereby given my consent to participate in clinics, workouts, practices, beach tournaments, other
tournaments, competition, field trips and other activities with Collegiate Beach Volleyball Training, Inc, Del Rey Volleyball and affiliated companies in 2011 and 2012. I
give permission for Del Rey Volleyball and affiliated companies to use pictures of my child in the future for publicity use only.
Parent / Guardian Signature:________________________________________ Date:__________________
The undersigned does hereby waive, release, acquit and forever discharge all coaches and others associated with Collegiate Beach Volleyball Training, Inc, Del Rey
Volleyball and affiliated companies and each of them from any and all acts, causes of action, claims, demands, damages, costs loss of service, expenses and
compensation, on account of or which may in any way develop out of any and all known and unknown personal injuries or property damages which the participant may
suffer during the course of or as a result of the participation in Collegiate Beach Volleyball Training, Inc, Del Rey Volleyball and affiliated companies’ activities,
including but not limited to the activities themselves, time spent after the activities, and travel to and from the activities.
The undersigned does hereby waive, release, acquit and forever discharge Collegiate Beach Volleyball Training, Inc, Del Rey Volleyball and affiliated companies, its
officers and directors, collectively and individually, coaches, and adult supervision, and any and all persons directly or indirectly associated with Collegiate Beach
Volleyball Training, Inc, Del Rey Volleyball and affiliated companies, and each of them from any and all acts, causes of action, claims, demands, damages, costs or
expenses on account of or which may in any way develop out of any and all known and unknown personal injuries or property damages which the participant may suffer
during the course of or as a result of participation with Collegiate Beach Volleyball Training, Inc, Del Rey Volleyball and affiliated companies throughout 2011 and 2012,
including but not limited to clinics workouts, practices, beach tournaments, other tournaments, competition, field trips and other activities, and travel to and from the
activities.
I hereby acknowledge that I am the lawful parent and/or guardian of the above-mentioned minor. I give authorization to any properly licensed physician or surgeon to
provide medical care and/or emergency treatment when necessary. Any expenditure for care and treatment is my responsibility.
Parent / Guardian Signature:__________________________________________ Date:___________________
Participant Signature:____________________________________ Date:___________________
Please Print Name of Parent / Guardian:____________________________________
Please Print Name of Participant:_____________________________________
Collegiate Beach Volleyball Training Program
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Waiver & Application
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