Clone of Summit Volleyball Club Lite Mar/Apr 2025

Summit VolleyPrep

Welcome to the registration for Summit Volleyball's VolleyPrep!

This program is for 3rd, 4th and 5th graders.

Program length: January-March (1x practices a week and 3-5 tournament dates.)

Where: OPS, 10106 E Dupont Cir. Dr, Ft. Wayne, IN 46825 or

Ash Center, 1701 Freeman St. Ft. Wayne, IN 46802

Cost: Total Cost: $550 + Jerseys

Signup Fee of $100 (due today)

2 payments of $225 (due on the 20th of January and February)

Full payment upfront will recieve a 10% discount off of $550.

IF PAYING IN FULL: Total due today: $495 + jerserys(Due Jan)

After you complete this form, you will be redirected to Snap Spend to pay the signup fee. If you choose the Pay in Full option, that will be reflected on your Snap Spend invoice either the same day or 1-2 days after registration. Out of the list of options please choose Summit VolleyPrep. Proceed to make the online payment via e-check (free) or credit card (fees apply).

If you have any questions about payment, please contact teddiemeyer@summitvball.com. If you have any questions reguarding the program, please reach out to Alliebennett@summitvball.com.

Player Information

First name

Last name

Date of birth

MonthDayYear

Player Age

Player School

Player Grade

Tshirt Size

Address Information

Street address

Street address line 2

City

State

Postal zip code

Payment Information

Please choose a payment option:

Parent/Guardian Information

Parent's/Guardian 1 Name

Parent's/Guardian 2 Name

Phone number

Email address

Emergency Contact 1

First name

Last name

Primary phone number

Secondary phone number

Emergency Contact 2

In the event of an emergency, please contact:

First name

Last name

Primary phone number

Secondary phone number

Medical Information

Medical Insurance Company

Medical Insurance Policy Holder Name

Medical Insurance Phone Number

Policy Number

Physician's Name

Hospital of choice

Does the athlete have any allergies we should be aware of?

If so, please explain.

Does the athlete have any medical conditions we should be aware of?

If so, please explain.

Release and Waiver of Liability

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND IDEMNITY AGREEMENT (“AGREEMENT”)In consideration of participating in Summit Volleyball– at OPS. I represent that I understand the nature of this Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the Activity. I fully understand that this Activity involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the “releasees” named below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and responsibility for losses, costs and damages I incur as a result of my participation in the Activity. I hereby release, discharge, and covenant not to sue OPS, its respective administrators, directors, agents, officers, volunteers and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the “RELEASEES” herein) from all liability, claims, demands, losses, costs, or damages on my account caused or alleged to be caused in whole or in part of negligence of the “releasees” or otherwise, including negligent rescue operations; and I further agree that if, despite the release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the releases from an loss, liability, damage, or cost which any many incur
as the result of such claim. I have read this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMINITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without inducement or assurance of any nature and intend it be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue infull force and effect.

Name of Participant

First NameLast Name

Signature of Guardian

Date