1. sports
2. volleyball

SWEITZER BEACH VOLLEYBALL CLINIC
Summer 2012 – Player Registration Form
CHILD’S NAME: ____________________________Date of Birth:______________
Beginner Player (Yes or No): ________ Returning SBVC Player (Yes or No): ___________
List prior volleyball experience & training (returning SBVC Players can skip this question)
_______________________________________________________________________
Current Grade: ___________ School: __________________________________________
Home Address:____________________________________________________________
Street
City
Zip
Email Address: ______________________________________________________
Mother’s Name: ______________________Father’s Name: ___________________
Mother’s Home Phone: _________________Mother’s Cell: ____________________
Father’s Home Phone: __________________Father’s Cell: ____________________
Which is the best phone number to reach you: _______________________________
Other than parents, at least Two Emergency Contacts – Name & Phone Numbers:
_________________________________________________________________
Pediatrician Name & Phone No: __________________________________________
Dentist Name & Phone No: _____________________________________________
Medical Insurance Carrier: __________________Name of Insured: _____________
Group/Policy No.: _________________________Phone (on back of card): _________
Occasionally, we post new pictures on the website. Do we have your permission to use
photos where your daughter/son appears in them (no names shown) Yes_____No_____
SESSIONS: (PLEASE MARK ONES YOUR CHILD IS WANTING TO ATTEND)
Total
________
JUNE 7 & 8, 9am to 2pm
$50
Paid:$_______
Date Paid:
________
JUNE 21 & 22, 9am to 2pm
$50
____________
________
JULY 12 & 13, 9am to 2pm
$50
Registration 
________
AUGUST 9 & 10, 9am to 2pm
$50
Waiver 
Total:
Check/Cash:
#___________
BY SIGNING BELOW, YOU AGREE TO IMMEDIATELY NOTIFY US Skill
IN WRITING OF ANY CHANGES TO THE ABOVE INFORMATION Level:_______
_
_______________________________________________
PARENT SIGNATURE
_______________
DATE
Print out & Mail Registration/Waiver and Payment to: Celeste Sweitzer
9814 Kapalua Lane, Elk Grove, 95624
WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT
I/We, the undersigned, are the parents and/or legal guardians (circle one) of the minor child
named below. We wish to enroll our minor child to participate in Sweitzer Beach Volleyball Clinic,
Sweitzer Personal Training programs and/or activities, including Volleyball, Sand Running, Plyometrics,
and Swimming. I AFFIRM THAT I HAVE READ THIS DOCUMENT AND I UNDERSTAND ITS
CONTENTS. I, and parent/guardian of _________________, acknowledge that volleyball or any sporting
event is an extreme test of a person’s physical and mental limits and carries with it the potential for death,
serious injury or property loss. With a full understanding of the potential risks, I HEREBY ASSUME
THE RISKS OF MY CHILD PARTICIPATING IN THIS VOLLEYBALL CLINIC.
I hereby take the following action for myself, my executors, administrators, heirs, next
of kin, successors and assigns: a) I WAIVE, RELEASE, AND DISCHARGE from any and all
claims or liabilities for death or personal injury or damages of any kind, which arise out of or
relate to my son or daughter’s participation in volleyball clinic and the above activities, THE
FOLLOWING PERSONS OR ENTITIES: Chad and Celeste Sweitzer, Sweitzer Beach
Volleyball Clinic, Sweitzer Personal Training, NCVA, USA Volleyball, any respective directors,
officers, employees, volunteers, agents, contractors, and representatives (collectively
“Releasees”); b) I AGREE NOT TO SUE any of the persons or entities listed above for any of the
claims or liabilities that I have waived, released or discharged herein; and c) I INDEMNIFY
AND HOLD HARMLESS the persons or entities mentioned above from any claims made or
liabilities assessed against them as a result of my actions.
Since the participant is a minor, the undersigned Parent or Guardian (circle one) of
_________________(minor’s name) hereby executes the foregoing Waiver and Release, the following, for
and on behalf of the minor named herein. I hereby bind myself, the minor and all other assigns to the terms
of the Waiver and Release. I represent that I have legal capacity and authority to act for and on behalf of
the minor named herein, and I agree to indemnify and hold harmless the persons or entities mentioned
above for any claims or liabilities assessed against them as a result of any insufficiency of my legal
capacity or authority to act for and on behalf of the minor in the execution of the Waiver and Release.
Further, if during the course of my son or daughter’s activities, he or she should become ill or
sustain and injury, I hereby authorize Celeste Sweitzer, Sweitzer Beach Volleyball Clinic, or
Clinic Staff to obtain emergency medical/dental care. I will assume financial responsibility for all
bills incurred.
NAME OF MINOR CHILD (PLEASE PRINT): _____________________________________
_________________________________________________
PARENT/GUARDIAN - PRINTED NAME
_________________________________________________________________________
PARENT/GUARDIAN – SIGNATURE
_________________________
DATE
______________________________________
DATE
Print out & Mail Registration/Waiver and Payment to: Celeste Sweitzer
9814 Kapalua Lane, Elk Grove, 95624