25-26 KRVA Site COI Request
Certificates are good September 1 to August 31 each season. Complete this form to have USA Volleyball events sanctioned. You need to complete this form for each facility that you plan to use and for each event (i.e. practice, tournament, camps/clinics).
Name
*
First Name
Last Name
Phone Number
*
Email
*
example@example.com
Club
This is a Request for Sanction For:
*
Practice
Tournament
Camp/Clinic
Name of this Facility
*
Address of this Facility
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Days for This Facility
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Times for the Facility
*
Start Date For this Facility
*
-
Month
-
Day
Year
Date
End Date For this Facility
*
-
Month
-
Day
Year
Date
Contact Name at this Facility
*
First Name
Last Name
Contact Email of this Facility
*
example@example.com
Contact Number of this Facility
*
Is General Certification Required for this Facility?
*
Yes
No
Is a Certificate for Additionally Insured Required?
*
Yes
No
If Yes, what are the names of the Additionally Insured parties?
My organization agrees to abide by all USA Volleyball and KRVA Rules and Policies for events.
I Agree To Abide
I Do Not Agree To Abide
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Facility Walk Through Check List
Facility suitable for volleyball practice and tournament play
*
Yes
No
Checked floor surfaces for defects or trip and fall hazards
*
Yes
No
Checked low hanging lights, heating units, plumbing, and basketball backboards
*
Yes
No
Adequate seating - bleacher seating in good repair
*
Yes
No
Men’s and Women’s restrooms in good repair
*
Yes
No
Men’s and Women’s locker rooms in good repair
*
Yes
No
Limited access to balance of school or facility
*
Yes
No
Limited access to wrestling mats and gymnastics equipment
*
Yes
No
Volleyball standards padded and in good repair
*
Yes
No
Is there a school official or facility representative on premises during use of facility?
*
Yes
No
Are there procedures for advising venue owner of problems?
*
Yes
No
Quick access to phone in the event of emergencies?
*
Yes
No
Have maintenance/security personnel been advised of your rental of the facility?
*
Yes
No
Is a key required to gain access to the facility?
*
Yes
No
Are exits marked and doors unlocked? (no chains securing double doors)
*
Yes
No
Rental Agreement required
*
Yes
No
Are there well-lit & monitored parking spaces?
*
Yes
No
Are there secure “team” parking areas?
*
Yes
No
Is there an Emergency Response plan at facility for evacuation & medical emergencies?
*
Yes
No
Is there a responsible party for removing unruly spectators?
*
Yes
No
Are lighting and electrical systems checked at facility? Any emergency lighting?
*
Yes
No
Submit
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