Co-ed Volleyball Signups

* indicates a required answer.

Participants either need to register online to play the for the entire 8 week session OR you may signup here if you are just paying per night(s) you attend at a cost of $15/student/night.

1. *

Student Name:

2. *

Complete Address:

3. *

Email

4. *

Parents Name

5. *

Phone number:

6. *

Email (if different from students)

7.

Volleyball Skills

Beginner Intermediate
Advanced Advanced and have played competitively
8.*

Student Age (as of September 1st)

9.

Date(s) student will attend volleyball sessions if known

 
January 16th January 23rd
January 30th February 13th
February 20th February 27th
March 5th March 13th
10.*

Is your child currently taking any medications?

 (1 required)
Yes No
11.

If yes, list all medications your child is currently taking:

12.

List known allergies:

13. *

Emergency Contact Number for parent:

Emergency Contact Information: (other than a parent)

14. *

Name/Relationship:

15. *

Home Phone:

16. *

Cell phone:

17.*

In the event of any injury or emergency, if I or my emergency contact cannot be notified, I authorize the individual(s) in charge to obtain emergency medical treatment for my child as deemed necessary by competent medical personnel. I understand that I am fully responsible for any and all charges incurred in the event of such treatment.

18.

Please feel free to add any comments or questions for the adminstrators.