Riptide Volleyball Registration Form

Player Name

First NameLast Name

I'm registering for:

Player Birthdate

Date

Guardian / Parents Names

First NameLast Name

Address

Street Address

Street Address Line 2

City

Postal / Zip Code

Home Phone

Format: (000) 000-0000.

Cell Phone

Format: (000) 000-0000.

E-mail

example@example.com

Volleyball skill level

	1	2	3	4	5

1 is Begginer, 5 is Advanced

Emergency Contact & Health Insurance Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

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

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

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Format: (000) 000-0000.

Release of Liability

Although the safety of all sport activities is the primary concern, indoor sport activities at RBVC's facilities 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 RBVC and the persons in charge.

Photo/Video Resease Form

I hereby give permission for images of my child, captured during the Riptide Volleyball Academy season at practices,tournaments and events through video, photo and digital camera, to be used solely for the purposes of Riptide Volleyball Academy promotional material and publications, including website and social media entries, and waive any rights of compensation or ownership thereto. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein a likeness appears.

I hereby hold harmless and release and forever discharge the Riptide Volleyball Academy from all claims, demands, and causes of action which I, my heirs,
representatives, executors, administrators and any other persons acting on my behalf.

I have read this release before signing below and I fully understand the contents, meaning and impact of this release.

I have read and agree to the above conditions

How did you hear about us?

Confirmation/Contact E-mail

example@example.com

Signature

Monthly Program Options

Indoor Club Developmental ($285.00 for 1 month)

Two days of training per week. (8 lessons/month)

Dev Indoor + Beach($385.00 for 1 month)

4 Days Indoor per Week & 3 Days Beach per Week to choose from (20 Lessons/month)

Beach Silver Monthly($200.00 for 1 month)

2 Days Per Week Training (8 Lessons/month)

Beach Monthly Unlimited($250.00 for 1 month)

3 Days Per Week Training + Indoor option for rain days (12 lessons/month)

Release of Liability

Monthly Program Options*

Monthly Program Options