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 20th Note time: 6 - 10pm
February 27th - Note time: 6 - 10pm March 5th - Note time: 6 - 10pm
March 13th - Note time: 6 - 9pm
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.