GVVL Volleyball Clinic Online Registration - Part I

* Firstname:	* Lastname:
* Date of Birth:	* Gender:
* Grade: (Sept. 2011)
* School: (Sept. 2011)

* Street Addr.:
* City:
* State: Zip: *

* Parent/Guardian:
* Telephone:	Cellphone:
Father's Employer:
Mother's Employer:
* Parent's Email Address:
* Verify Email Address:

If different: Parent/Guardian:
Alternate Address:

In the event of an emergency, GVVL will attempt to contact the above named parent. Secondary contact name: * Telephone number: *

GCVO/GVVL is %100 run by volunteers. Your contribution is:
Coach	Asst. Coach	Referee	Cleaning	Team Parent	Fundraiser
Misc Help - picture day, passive help at fund raisers, mail flyers, etc.


LEGAL REQUIREMENTS (DO NOT ALTER) I. INDEMNIFICATION AND HOLD HARMLESS AGREEMENT
The undersigned, parent/guardian of the above named youth hereby give my permission for this youth to participate in all GVBL activities, including practices, games, tournaments, and travel to and from such events, sanctioned expressly or implicitly by GVBL or its authorized representatives. On behalf of this youth, I assume all risks and hazards incidental to such participation; I hereby release GVBL from any and all liability which may arise from any injury from whatever reason to the above mentioned youth as a result of his/her participation. Further, in considerations of this youth's participation in the GVBL Program, I agree to INDEMNIFY and hold GVBL Affiliated Organizations, the Organizers, Sponsors, Supervisors, Participants, Coaches, Referees, Land owners and any persons transporting this youth to and from GVBL and related activities, HARMLESS for any claim for any injury, damage, loss, costs, and/or expenses of any kind arising out of this youth's participation in these activites, whether such damages are the result of negligence or for any other reason or cause. I also agree to discharge forthwith, on request of GVBL and its Authorized Representatives, each and every obligation or claim which shall be made, assigned or apportioned against GVBL or its Authorized Representatives by any party by virtue of absolutely any injury or damage caused to : * (firstname lastname as entered above)

II. Medical Release
a) In the event of injury or sickness, the parent or guardian authorizes GVBL Team representatives to transport and admit the above named youth to any convenient hospital or similar facility for emergency medical treatment. The parent or guardian authorizes said Hospital to commence treatment. b) The above named player has no known medical or allergies except as follows (if none, then the word "none" must be written in this space): * c)Further, the parent/guardian hereby acknowledges adequate personal medical insurance coverage for the above named youth. No child will be permitted to play without providing to GVBL evidence of insurance coverage.
* Health Insurance Company:
* Health Insurance Policy Number:

III. Acceptance
By indicating your acceptance, you understand, agree, warrant and covenant as follows: That by registering a child under the age of 18, you represent and warrant that you are the parent or legal guardian of that party and have the legal authority to enter into this agreement on their behalf and by proceeding with this event registration, you agree that the terms of this Agreement and Waiver shall apply equally to all Registered Parties. By registering a child under 13, you agree and consent to the collection of that child's information which you provide for the purposes of registration. Parent/Guardian Name: *

IV. Photography Waiver
Great Valley Community Organization (GVCO) would like to post pictures to a photo gallery on its websites, www.gvbl.org and/or www.gvco.org. In order to use a picture on the website, a photo waiver needs to be signed by the child’s parent /guardian. Photographs taken may be used in future public materials (including but not limited to posters, brochures, advertisements, slide shows and the website). By signing below I give permission to GVCO to use any and all photographs taken of of the above named youth for posting on the website or printed material. I hereby waive any rights or interests that I might have in any or all images. Parent/Guardian Name: