GCJrs Mini Season Registration Form

Youth Mini Season & Travel Registration

Elementary & Middle School 10U-14U

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

Mini Season Training - Monday & Thursday

10U - 12U 5:30-7PM

13U & 14U 7-9PM

New Hope Baptist Church

9422 Old Tampa Rd

Parrish, FL 34219

8/31/21 - 10/28/21 (2 Local Tournaments)

-----Travel Season Training 2x per week TBD-----

November 2021 - April 2022

OVERNIGHT AND/OR OUT OF STATE TRAVEL IS REQUIRED

Please indicate Mini Season / Travel Season or Both. Registration fee is $50 per team try out.

Mini Club ONLY (AUG-OCT) $50 Travel Club ONLY (NOV-APR) $50 Mini & Travel BOTH $100

PLEASE NOTE:

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

GCJrs will continue with the following COVID-19 protocols:

Use hand sanitizer or wash hands upon entering facility
Bring a towel to wipe face & hands during practice
Parents are not permitted to spectate
If you suspect you have been exposed to someone known to have COVID-19, have a fever or have not been feeling well in the last 3-5 days, please stay home!

MINI Club Tryout Fee: $50

TRAVEL Club Tryout Fee Additional: $50

MINI-Season Fee: $425 (practices 90 min) Monday & Thursday

8/31

9/2, 9/9. 9/13, 9/16, 9/20, 9/23, 9/27, 9/30

10/4, 10/7, 10/11, 10/14, 10/18, 10/21, 10/25, 10/29

2 Tournaments in Sept/Oct

Includes 1 GC logo Tee-shirt & 1 Team jersey

Knee pads & navy blue spandex will be required for tournaments.

(Teams will be limited to 10 players. There are circumstances that we may take 11 but that would be the exception.)

Athlete Information

Player Name *

First Name Last Name

Player DOB: *

Player Age *

Player's Height?

Player's Dominant Hand?

Right Left

Player's School *

Player's School Grade:

Fifth Sixth Seventh Eighth

Preferred Jersey Number:

Shirt Size: *

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

AAU Membership #: (ADD Club code: WYD8AU *

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

Parent/Guardian #1 *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone

Area Code Phone Number

Cell Phone *

Area Code Phone Number

E-mail *

Parent/Guardian #2

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone

Area Code Phone Number

Cell Phone

Area Code Phone Number

Email

example@example.com

Volleyball skill level *

	1	2	3	4	5

1 is Beginner, 5 is Advanced

Are you willing to be a team representative or sponsor?

Team Parent Scorekeeper Sponsor Food Parent

Emergency Contact & Health Insurance Information

Emergency Contact's Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Relationship *

Do you have health insurance ? *

Yes No, I'll pay with cash.

Insurance Carrier

Name of Policy Holder

Subscriber ID/Group Number

Card Number / Card Date

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

Yes No

Please describe *

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# *

Area Code Phone Number

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 *

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.

How did you hear of GCJrs? *

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)