2026 Club Director Verification Form

Thank you for registering one or more teams in a Heartland Volleyball playdate or tournament in 2026 operated under the guidelines of the Junior Volleyball Association (JVA). As club director, please read the information below and provide a ONE-TIME waiver and liability approval that will ensure JVA compliance for all the teams in your club for the 2026 Heartland Events season.

Club Name

Club Affiliation

Name (Club Director)

First NameLast Name

Club Director Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Club Director Email Address

example@example.com

Number of teams from your club competing in Heartland Events

Events Registered For: (select all that apply)

JVA compliance is defined as follows:

JVA requires that each member of each of your teams sign a JVA Waiver of Liability Form and a JVA Medical Waiver and Release Form (a USAV Medical Waiver and Release Form is acceptable) and that a hard copy of those forms are in the possession of the Coach/Team Rep at all times, or available online to the Coach/Team Rep via SportsEngine.

These waivers are NOT to be sent to Heartland Volleyball, rather they are to be kept in the possession of the Coach or Team Rep for the entirety of each of Heartland Volleyball's events. The form must be submitted regardless of team affiliation (JVA, USAV, AAU, etc).

If an individual is injured during participation in a Heartland Volleyball event, it is the coach’s responsibility to secure a “JVA Incident Report” from the Tournament Director. The form should be completed and retained by the Tournament Director. It is advised that the coach request a copy for the club records. For more information contact Lisa Wielebnicki at lisa.wielebnicki@jvavolleyball.org.

As the club's Authorized Representative I assume all liability and attest that all adults working with my club's teams and the minor athletes therein at any 2026 Heartland Event are in full compliance with the "... Safe Sport Act of 2017." Further, I have read, all JVA insured event requirements and will supply any and all forms to the event upon request, including but not limited to, JVA Event Waiver, Medical Forms for each athlete and any and all items needed to confirm compliance with the JVA's Background Screening and APS Policy.

As the club's Authorized Representative I attest that the individuals on the roster as established and furnished to JVA, AAU or USAV are the athletes that will be in attendance and participating in the event. If, due to illness, an athlete is unable to attend and the team has less than six players, I will contact the event director immediately to request an addition to the roster to ensure participation.

Signature

Today's Date:

Date