IPV Event Waiver Form

Participant Information: *Click here for PRINT FRIENDLY verson
Athletes Name: _________________________ Parent Name:________________________
Address: _____________________________ City__________________Zip_____________
Phone: ________________ Parent Cell or Emergency Contact: _________________
Email Address: ________________________@ ________________
School: _______________________________ Grade in fall: ___ B-day: ______
Height:______Hand:_____Preferred Position (S/OH/MH/Ds…)____________________
VB Experience: ____________________________________________________________
Type of Clinic/Lessons (Private/Hitters Club…)_________________________________
Amount Due:__________ Check #:_______ Date Paid:_____________
I grant permission for clinic/lesson photos (including my daughter) to be posted on the Illinois Performance Volleyball, Inc. (www.ipvbc.com), or IPV Social Media sites.
I grant Illinois Performance Volleyball, Inc. (IPV) permission to contact me about future clinics, lessons, volleyball programs and tryouts.
I hereby grant permission for my daughter _______________________________, to attend clinics/lessons offered by Illinois Performance Volleyball, Inc. My daughter has no medical condition that would interfere with her participation in the clinic. I release the clinic/lesson instructors, clinic/lesson facility and all staff from any liability from injuries which may occur.
Parent Signature: _________________________ Date: _________
If, during the course of my daughter’s/son’s activities in volleyball, she should become ill or sustain an injury, I do authorize the Illinois Performance Volleyball, Inc. staff to obtain emergency medical/dental care. I will assume financial responsibility for the bills incurred through my insurance company.
OR Parent Signature: __________________________ Date: _________ I do not authorize emergency medical/dental care for my daughter/son.
Parent Signature: ________________________ Date: _________