2019 Tryout Registration
Please read careful and fill out every question to register - $25
Level of Experience
Beginner - 0 to 2 years
Moderate - 2 to 4 years
Select - 4 to 6 years
Advanced - 6 plus years
Level Trying Out For
Winter Local 4 Month
Spring Local 3 Month
Competitive 7 Month
National 7 Month
Other sports played and /or other club sports
How did you hear about us? (circle all that apply)
-- Select Course --
High School Coach
Other, explain below
Parents please fill out this information complete.
Primary Insurance Company
Primary Group / Policy #
Does your policy cover sports related injuries?
In the past 24 months, have you been tested, diagnosed and/or treated for a concussion?
If Yes please provide the information below
If Yes to the above question, provide the date (months and year), who performed the testing/diagnosing/treatment and what was the outcome.
Allergies? please list
If no allergies please write NONE
My child who is listed above has my permission to participate in training, competition, events, activities and travel sponsored by Attack Volleyball Club. I approve of the leaders who will be in charge of this program. I recognize that the leaders are serving to the best of their ability. I certify that the participant has full medical insurance with the company listed above. I understand and agree that this document will be kept in the possession of authorized adult team personnel and that reasonable care will be used to keep this information confidential. I agree to allow the authorized adult team personnel to release this information in the event of a medical emergency to a third party medical provider. I also certify to the best of my knowledge that the participant named hereon is physically fit to engage in the activities described above.
To the Club Leaders/Coaches/Volunteers:
If, during the course of my daughter’s activities in volleyball, she should become ill or sustain injury, I hereby authorize you to obtain emergency medical/dental care.
I will assume financial responsibility for the bills incurred through my insurance company.
I Disagree and will take care of this myself
Please read entire waiver and then select I AGREE to finish this form
I hereby acknowledge that participation in the Attack Volleyball Club competitive teams, training, or
instruction of any kind as well as any related activities is at the sole discretion and judgment of the
parent or guardian and involves the risk of physical injury. I understand that the minor's voluntary
participation in the Attack Volleyball Club programs involves potential risks of injury, both serious and
minor, including but not limited to head or other injuries, broken bones, brain damage, paralysis and
most unforeseen to be death. I, on behalf of my daughter, hereby assume all such risk. I hereby
release and agree to hold harmless Attack Volleyball Club LLC, its coaches, and the Facilities for which
they occurred from claims, actions, damages and liabilities for personal injury or damage relating to
or arising out of any activities. The Club is not responsible for children who leave the practices, clinics
or other Club activities or programs without adult permission or accompaniment. As parent or legal
guardian of the minor, I hereby certify that I know the minor's state of health and wellbeing and that
the minor is physically fit to participate in the Attack Volleyball Club's activities and programs and that
I am unaware of any medical condition which might make the minor's participation inadvisable. As
parent or legal guardian of the minor, I hereby represent that the minor has health insurance
coverage sufficient to provide for any and all medical or dental services related to injuries, both
serious and minor, arising out of or connected with the minor's voluntary participation in the Attack
Volleyball Club activities and programs. Attack Volleyball Club is not responsible for lost or stolen