GCJrs Mini Season Registration Form

Please indicate previous experience:

Academy I - Beginner (No Team Experience) Academy II- Intermediate (Camp or Some Team Experience) Academy III- Int/Advanced (13U+ & 1 FULL Year Competitive Team) Academy IV- Advanced (14U+ & 2+ Years Competitive Team) Other

Please indicate sessions that you plan to attend.

COMPLETE Spring 2: May 5, 10, 12, 17, 19, 24, 26, 31 Summer 1: June 2, 7, 9, 14, 16, 21, 23, 28 Summer 2: June 30, July 12, 14, 19, 21, 26, 28 & August 2

Extended Season & Summer Registration

Ages 9U - 16U

Some age exceptions may apply - please call for more details!

$235 Per session [Cash/Check Only]

Drop-in $35 per session based on availability [Cash Only]

Academy Clinic/Training - Tuesday & Thursday

Academy I & II 6-7:30

Academy III & IV 7-9 pm

Parrish Community High School

7505 Fort Hamer Rd

Parrish, FL 34219

Cost per session is $235. Cash or check payable on first day of each session.

Dress appropriately.
- Knee pads and athletic shoes required.
- Logo practice Tee shirt
Water only! No food or soft drinks in the gym.
Arrive on time.

Questions? Please email Info@GulfCoastJrs.com

Athlete Information

Player Name *

First Name Last Name

Player DOB: *

Player Age *

Player's Height? *

Player's Dominant Hand? *

Right Left Other

Player's School *

Player's School Grade: *

Fifth Sixth Seventh Eighth Other

Volleyball skill level *

1

2

3

4

5

1 is Beginner, 5 is Advanced

Preferred Jersey #:

Shirt Size: *

Youth Medium Youth Large Youth XL Adult Small Adult Medium Adult Large Adult XL Other

AAU Membership #: (ADD Club code: W3449E) *

All players must have an AAU Extended membership. Go to www.AAUVolleyball.org and purchase an Extended Membership $16.

Primary Contact #1 *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone

Cell Phone *

E-mail *

example@example.com

Contact #2

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone

Cell Phone

Email

example@example.com

Emergency Contact

Emergency Contact's Name *

First Name Last Name

Phone Number *

Relationship *

Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy? *

Yes No

Please describe or type NONE: *

Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.

Name of Physician / Emergency Medical Care Facility *

Physician phone# *

Physician Address

Street Address

Street Address Line 2

City State

Zip Code

Release of Liability

Although the safety of all sport activities is the primary concern, indoor sport activities with Gulf Coast Jrs Volleyball club may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against Gulf Coast Jrs Volleyball Club and the persons in charge.

I have read and agree to the above conditions *

Yes No

COVID-19 Acknowledgement & Release of Liability

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID- 19 is extremely contagious and as a result, social distancing is recommended. Gulf Coast Jrs Volleyball Club (GCJrs) will follow state and local standards of conduct and has put in place reasonable preventative measures to reduce the spread of COVID-19 at its volleyball club activity (including but not limited to summer camp). However, even though such standards will be followed and reasonable measures put into place, GCJrs cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending this volleyball club activity could increase your risk and your child(ren)’s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and that my child(ren) and I may be exposed to or infected by COVID-19 by participating in the volleyball club activity and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at GCJrs Volleyball Club activity may result from the actions, omissions, or negligence of myself and others, including, but not limited to, club employees, coaches, volunteers, and program participants and their families.

Considering the foregoing, however, I grant permission for my child named on this form to participate in this volleyball club activity that may require transportation to a location away from the volleyball club site, notwithstanding the risks associated with the COVID-19 virus and group activities.

I confirm that there are no necessary changes to the Medical Information Consent form for my child that I previously submitted. If there are any necessary changes, I will complete another Medical Information Consent form.

I further agree on behalf of myself, my child named herein, and my spouse, our heirs, successors, and assigns, to release, indemnify, hold harmless, and defend GCJrs and their coaches, their members, directors, officers, employees, agents and representatives (“indemnitees”) associated with the event arising from or in connection with the negligent acts or omissions of the indemnitees’ in relation to prevention of the spread of the COVID-19 virus. I SPECIFICALLY ACKNOWLEDGE AND AGREE THAT I AM AGREEING TO DEFEND, INDEMNIFY AND HOLD HARMLESS THE INDEMNITEES’ FROM THEIR OWN NEGLIGENCE IN REGARD TO THE INDEMNITEES’ NEGLIGENT ACTION AND/OR INACTION IN REGARD TO PROTECTION AGAINST THE COVID-19 VIRUS.

I have read and agree to the above conditions *

Yes No

Confirmation E-mail *

example@example.com

Signature *

Clear

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at Info@GulfCoastJrs.com.

Type a question

How did you hear of Gulf Coast Juniors? *

Previous Club/Clinic/Team Coach Email Facebook or other social media Internet search ie. Google School Friend or family (If you check this please add referrer's name below in OTHER) Other