Registration Form
SUMMER 2015 PROGRAMS All-‐Skills Camp: June 17-‐19th from 9:30AM-‐4:00PM (early drop-‐off & pick-‐up available) Camp will emphasize attacking, passing, setting, and serving. Players will be grouped by age and skill level. Lunch and camp shirts provided Ages: 8-‐15 Maximum Participants: 48, Coach/Player Ration 10:1 Head Coaches: Amy Jones & Victoria Cachapero, Assistant Coaches: RVVC-‐Pursuit Staff coaches Location: Redlands Adventist Academy Cost: $210/player (sibling/friend discount $10. Limit of 4) Local’s League Teams (Girls Only)-‐Players may sign-‐up month to month or for the full season Teams practice 1/per week and compete in a minimum of 1 tournament per month. July: all teams practice on Monday or Tuesdays. August-‐November 1: Practice days will be determined by age groups. Age Groups: 8-‐11, 12-‐14, 14-‐16 (players may move up or down depending on skill) Cost: $105/month + $50 registration fee for player insurance, team shirt, socks Players may join at anytime and fees will be prorated. Boys’ Team (elementary/middle school) There will be one session of boys’ volleyball. 1 practice per week and one tournament on August 23rd at San Diego Volleyball Club July 20-‐August 23rd Cost: $160 (includes team shirt, waterbottle, drawstring bag) Classes Private Lessons: Available Upon Request Sundays, Mondays, and Wednesdays. Contact Coach Victoria: [email protected] or (909)754-‐3346 Indoor Clinics: (starts late June/early July) Ages 8-‐16 Cost $25 or 4 for $80 Mondays evenings (select Monday/Wednesday mornings) Grass Volleyball: (classes are held from 5:30-‐7:30PM) June 8-‐26th Ages 15&Under Locations: Loma Linda (June 9, 11, 16, 18), Redlands (June 8, 10, 15, 22) Grand Terrace (June 23, 25, 30, July 2), Yucaipa (16, 18, 23, 25), Riverside (TBA) Cost: $25/class or 4 classes for $70 Sand Volleyball League (Co-‐Ed, Ages 14-‐18) Level Intermediate/Advanced Training Month (Wednesdays): June $90 League (Wednesdays): July 1-‐August 14th $170-‐includes tank top Training Month + League: $240 RVVC-‐Pursuit Satellite Branch Summer 2015 Registration Form Student Name: DOB Last First Middle Student Name: DOB Last First Middle Student Name: DOB Last First Middle Address: City: State: Zip: School: PARENT INFORMATION Mother: Father: Address: Address: City, Zip: City, Zip: Phone: Phone: Email: Email: MEDICAL INFORMATION Emergency Contact Name: Emergency Contact Phone: Insurance Company: Policy Number: PROGRAM INFORMATION: PLEASE CIRCLE ALL THE PROGRAMS YOU ARE REGISTERING FOR Texting Ok:Yes/No CHILD NAME Volleyball Camp Grass Grand Terrace Grass Loma Linda Grass Redlands Grass Riverside Grass Yucaipa Girls’ Local League Boys’ Summer League Sand Volleyball Clinics Private Lessons Texting Ok:Yes/No CHILD NAME Volleyball Camp Grass Grand Terrace Grass Loma Linda Grass Redlands Grass Riverside Grass Yucaipa Girls’ Local League Boys’ Summer League Sand Volleyball Clinics Private Lessons CHILD NAME Volleyball Camp Grass Grand Terrace Grass Loma Linda Grass Redlands Grass Riverside Grass Yucaipa Girls’ Local League Boys’ Summer League Sand Volleyball Clinics Private Lessons Mailing Address: DIGS Volleyball: PO BOX 12214, San Bernardino, CA 92423 Payment Methods: CHECKS PAYABLE TO DIGS/PURSUIT VBC, Online Payments Available DIGS Volleyball Program Liability Waiver 2015 Minor Waiver and Release Liability I/We agree to indemnify and hold harmless the sponsors, Mesa Grande Academy, Loma Linda Academy, Redlands Adventist Academy, Drayson Center, Jehue Middle School, California State University San Bernardino and Southeastern California Conference of Seventh-day Adventists and all other practice facilities, for liability arising from any accident or injury occurring during this activity. This specifically includes injury arising from negligence on the part of those mentioned above. This recognizes a shared responsibility between activity sponsors, participant and home. This does not include gross negligence on the part of those mentioned above. This is not a Mesa Grande Academy, Loma Linda Academy, Jehue Middle School, Crafton College or a Redlands Adventist Academy sponsored activity and is therefore not covered under Student Accident Insurance. Participant and Parents or Legal Guardians declare to DIGS that participant is in physically sound condition and has no disability, illness or other condition preventing the participant from engaging or otherwise participating in sports or other physically challenging activities. Participant, parents, and legal guardians understand and acknowledge that participation involves an element of risk and/or danger for all participants and may cause serious injury, death or property loss. I/we, the parent(s) or legal guardian(s) fully understands, accepts and assumes any and all risks in connection with the participation in these activities. I/we, the parent(s) or legal guardian(s), hereby consent and agree to release, indemnify, and hold harmless DIGS, any agent, employee, volunteer, or person associated with DIGS Volleyball, Mesa Grande Academy, Loma Linda Academy, Redlands Adventist Academy and the Southeastern California Conference of Seventh-day Adventists and its associates will not be held liable or responsible for any death, injury, nor the loss, theft of personal property of any kind which arise out of or are related to my child’s participation in or traveling to and from the volleyball event. Signing this waiver means that it is understood and acknowledged that this waiver is a signed contract between DIGS and participant and parents or legal guardians. Printed Name of Participant Date Printed Name of Parent/Legal Guardian Signature Relationship to Participant Emergency Medical Release I (Parent/Legal Guardian) authorize all medical, surgical, diagnostic and hospital procedures as may be performed or prescribed by a physician for my child. If I cannot be reached in case of emergency, I hereby grant permission to DIGS to have my child treated by a physician if necessary. I understand that I am responsible for any and all medical expenses due to my child’s illness or injury. Parent/Legal Guardian (Signature) ___________________________Date: __________________ Emergency Phone: ( ) ___________ - _______________ Photo Consent We are requesting permission for your participant’s photo to be published on the DIGS/PURSUIT Volleyball website, social media and marketing materials. I/We GRANT permission for this participant’s photo to be published I/We DO NOT GRANT permission for this participant’s photo to be published.
© Copyright 2024