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Houston Slam Volleyball

* Required Field

Registration, Waiver, Club Form

Your last name:

Your first name:

D.O.B.

Address:

City:

Zip:

Cell
Phone:

Home
Phone:

Email:

School:

Grade:

Parent
Name:

Parent
Phone:

Parent
email:

Address:

City:

Zip:

Emergency Contact Name:

Emergency Contact Phone:

Name of Insuranced:

Name of Insurance Carrier:

Insurance Policy Number:

Consent Statement
I hereby give permission for my daughter/son to participate in the Slam Volleyball Club.
This authorization shall waive, release, and absolve the Slam Volleyball Club and Staff from
liability for injury or illness incurred at the camp. I give the camp staff permission to act for
me according to its best judgment in case of emergency.

Cancellation Policy:
** If you cancel after the deadline, but prior to the start date you will only be refunded 50%.
No refunds will be given after the start of any league, camp or training**

Participatipation Waiver:

In consideration of being allowed to participate in the program is significant, including the
potential for permanent paralysis and death.

I knowingly and freely assume all such risk, both known and unknown, even if arising from
the negligence of the releasees or others.

I willingly agree to comply terms and conditions for participation. I observe any unusual
significant hazard during my presence or participation, I will remove myself from
participation and bring such to the attention of the nearest official immediately.

I, for myself and on behalf of my heirs, assign, personal representation and next of kin,
hereby release, indeminify, and hold harmless Houston Slam Volleyball, its officers,
officials, agents and/or employees, or the participants, sponsors, advertisers, and if
applicable, owners and lessors or premises used by leasees), from any and all claims,
demands, losses, and liability arising out of or related to any injury, disability or death I may
suffer, or loss or damage to person or personal property, whether arising from the
negligence of the releasees or otherwise, to the fullest extent permitted by law.

I have read this release of liability and assumption of risk agreement, fully understand its
terms, understand that I have given up substantial rights by signing it and sign it freely and
voluntarily without and inducement.

Participant's Name:

Participant'sSignature:

For parent's/gaurdians of participants or minor age (under age 18 at time of registration.)
This is to certify that I, as parent/guardian with leg I responsibility for this participant, do
consent and agree to his/her release as provided above of all the Releasees, and for
myself, my heirs,assigns, and next of kin, I release and agree to indemnify and hold
harmless the Releasees from any and all liability incidents to my minor child's involvement
of particpantion in these programs as provided above, even if arising from the negligence
of the releeses, to the fullest extent permitted by law.

Parent's Signature