Form – Small Group Training – Lakeside Volleyball Club

Program *

Select the name of the program that was included in your invitation email.

Name *

First

Last

Are you 18 or older? *

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Phone *

The participant (the “Athlete”) acknowledges that they are assuming risks that may have financial and other consequences for you and/or your family should you be injured while participating in, or observing activities relating to, volleyball training and/or game play.

The Athlete acknowledges and agrees that in exchange for, and as a condition of, their participation in the activity which they are registered, they shall assume full responsibility for any injury that may be sustained in connection with their participation in the activity for which they are registered. The Athlete further acknowledges that they:

• are aware that participation in the activity in which they are registered may be hazardous and could result in injury;

• are in satisfactory physical and mental condition to safely participate in the activity in which they are registered;

• have disclosed to the instructors of any allergy or other medical condition that may affect their ability to safely participate in the activity in which they are registered;

• are competent and have read and understand the terms of this document.

Accordingly, the Athlete hereby releases Lakeside Volleyball Club Inc, its agents, employees and volunteers from all liabilities, claims, demands, actions and causes of action of any nature whatsoever arising from or related to any injury, including loss of life, that the Athlete may sustain, howsoever arising, including any damage, loss, theft or destruction of property, injury or death resulting from the negligence of Lakeside Volleyball Club, its agents, employees or volunteers, while attending at, participating in or travelling to the activity in which they are registered.

DISCLOSURE SUMMARY:

By signing this waiver, the participant understands that they are not covered by insurance policies under Lakeside Volleyball Club, Ontario Volleyball Association, the Halton District School Board (HDSB), Halton Catholic District School Board (HDCSB) or any facility or subsidiary of related Organizations, Associations or Boards mentioned above.

The participant assumes all risk associated with participating in any activity facilitated by Lakeside Volleyball Club.

Date *

Signature *

Clear Signature

Use your mouse/finger to add your signature. Click the “x” button on the far right of the signature box to reset your signature.

Guardian Signature *

Clear Signature

Use your mouse/finger to add your signature. Click the “x” button on the far right of the signature box to reset your signature.