Player Name *

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Parent Names *

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Pertaining to membership in the Powers Volleyball Academy: 1. Acknowledgment of Risk and Parental Consent The player and parent/guardian should read this statement carefully. You should be aware playing or practicing to play volleyball in any manner can be a dangerous activity involving many risks or injury. These risks may include, but are not limited to death, serious neck, head and spinal injuries which may result in complete or partial paralysis, serious injury to other parts of the body, general health and well being. Because of the dangers of participating in sports, the player should recognize the importance of following the coaches’ instruction regarding playing techniques, training, and other team rules, and obey that instruction. 2. For myself, my executors, administrators, heirs, next of kin, successors, and assigns, I HEREBY: Waive any and all claims that I may have against Powers, its officers, directors, members, volunteers, employees, coaches, agents, USAV, AAU/JVA, and their heirs, next of kin, successors, or assigns (“the release”) including any and all claims for damage caused by the negligence of any of them arising out of my participation in volleyball and its related activities, together with any costs including attorney’s fees that may be incurred as a result of any such claim whether valid or not and release Powers, its officers, directors, members, volunteers, employees, coaches, sponsors of any liability resulting from injury or death during practice or competition and related activity. 3. I herby acknowledge that I have sole responsibility for my personal possessions and athletic equipment during the competition with Powers and related activities. 4. I hereby attest and verify I am physically fit and have sufficiently trained for this competition and my physical condition has been verified by a licensed medical doctor. 5. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during participation with Powers. 6. I hereby agree that in the event of cancellation of membership, by me or Powers, for whatever reason, any monies in my account will become the property of Powers. 7. I agree to the Powers payment and billing procedure and I understand that by signing this I am fully responsible for the entire fee.

I agree to the terms and conditions listed above.