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CENTRAL JERSEY VOLLEYBALL

NEW!!!2014 Middle School League Insurance Waiver!!!NEW

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IMPACT MSVB LEAGUE SCHEDULE 2014
Summer PLAY-OFF Schedule 2014
Summer League Coaches Agreement 2014
***IMPACT VB CLUB INFO 2015***
2014 IMPACT VBC TEAMS!!!
!!!SUMMER LEAGUE 2014 Info and Application!!!
2012 WINTER LEAGUE and IMPACT CLUB TEAMS!!!
NEW!!!Middle School VB League 2014 Application!!!NEW
NEW!!!2014 Middle School League Insurance Waiver!!!NEW
SUMMER LEAGUE 2014 Permission Slip
Maps/Directions

All Players MUST present this signed for before playing...

2014 Central Jersey Volleyball Club Junior League

 

PARENT/GUARDIAN CONSENT AND AGREEMENT

 

I acknowledge that as a member of the Central Jersey Volleyball Club Junior League, my daughter will participate in activities that involve physical activity, including physical contact with other persons and for objects such as the ground, sport equipment, facilities, etc. that may incur injury. I specifically waive and release the Central Jersey Volleyball Club, administrators and volunteers of the Central Jersey Volleyball Club from liability from any claim(s) for damages for injuries/illnesses which my daughter may sustain during her involvement in the athletic program.

 

In signing this form, I certify that my child is in good health, with no chronic illness or injury. If such conditions exist, I will notify the Central Jersey Volleyball Club of such conditions prior to my child's participation. In the event of any emergency in which my daughter requires medical treatment, I authorize the staff of the Central Jersey Volleyball Club Junior League to act on my behalf to obtain proper medical treatment, the staff member, in their best judgment, deems necessary and appropriate for my daughter. This will include, but not be limited to whatever necessary medical, surgical and dental examination, diagnosis and/or treatment that is deemed necessary by the treating physician.

 

In signing this form, my family, and I agree to follow all rules and regulations of the Central Jersey Volleyball Club Junior League.

 

Athlete's Name: (print)__________________________________________________

 

Home Street Address: ___________________________________________________

 

City:__________________State:_____Zip___________________________________

 

School : ___________________________________Grade: (as of 9/14)_____________

 

Parent/Guardian Name: (print)____________________________________________

 

Emergency Phone Numbers:   HOME (         ) ______________________________

 

                                                WORK:(         ) ______________________________

 

Email Address _______________________________________________________

 

Parent/Guardian Signature: _____________________________________________

 

Today's Date ________________________________________________________

 


 

 

PERMISSION/RELEASE FORM                         

Player's Name ________________________Date of Birth___________  Age___

Address   _____________________________City_______________State_____

School ________________________________________________ Grade_____

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

EMERGENCY CONTACT PERSON(S):

Name______________________________ Phone _______________________  

Address ___________________________  City _________________________

Name______________________________ Phone _______________________  

Address ___________________________  City _________________________

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

I give permission for my child to practice and play for the Central Jersey Volleyball Club Junior League during the  2014-15   season. I hereby waive and release any and all rights and claims for damages which I may have against any coach or agent of the  Central Jersey Volleyball Club Junior League for any and all injuries which my child may incur while taking part in your program. This release also encompasses any injuries which may be sustained while traveling to and from participation in your program. As a parent, I understand it is my responsibility to pick my child at the predetermined time and location- I also understand that if my child becomes ill or destructive, the above EMERGENCY CONTACT PERSON(S): will be called to take my child home if I cannot be contacted immediately.

Parent/Guardian Signature:____________________ Parent/Guardian Signature:______________________

Date;__________________ Telephone (         ) ______________________________

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

HEALTH HISTORY:

 

Does your son/daughter have any medical problems or allergies that we should be informed about? YES____NO ____

lf yes, please explain? _____________________________________________________

 

Is your son/daughter on any medications? YES____NO ____   If yes, please describe the type of medication, dosage, frequency of use and who is authorized in the administration _______________________________________________________________________

 

 

PARENTS AUTHORIZATION: This Health History  is correct so far as I know. I understand that this information will be kept strictly confidential and will be used in cases of injury or sickness and will be presented to medical personnel who might have to attend to my child in an emergency.

PARENTS

SIGNATURE: __________________________________________DATE:___________

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