Clone of West Polk Volleyball Academy Tryout Registration Form

WPVA Tryout Registration Form

Date: Saturday, September 19th Time: Ages 14 &15 - 9:00-10:30 Ages 12&13 - 11-12:30
Athlete Name

First NameMiddle NameLast Name
Athlete Birth Date

MonthDayYear
Athlete E-mail (if applicable)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Volleyball Experience
Parent/Guardian Name

First NameLast Name
Parent/Guardian E-mail
Parent/Guardian Phone Number
Format: (000) 000-0000.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Format: (000) 000-0000.
Relationship to player
Photo/Video Waiver: I knowingly give consent for the release of any photographic images that may be taken during my child’s participation in WPVA'S tryouts for the use by West Polk Volleyball Academy for its publications, promotional materials, social media, advertisement. I hereby grant permission to the rights of my child’s image, likeness and without payment or any other consideration. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.
Parental Consent (for minors)
Parental Consent (for minors)
Acknowledgment
Please choose one registration.
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Tryout Registration Fee
Online Payment

$35.00 Quantity

Tryout Registration Fee
Check/Money Order Being Mailed

Free Quantity

Total

$0.00
Payment Methods

Fastlane Checkout

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WPVA Tryout Registration Form

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