Athlete *

First Name

Last Name

Primary Guardian *

First Name

Last Name

Primary Guardian Phone *

(###)

###

####

Physician Phone *

(###)

###

####

Permission to Participate *

Participant, has my permission to participate in training, competition, events, activities and travel sponsored by HHCVC I approve of the leaders who will be in charge of this program. I recognize that the leaders are serving to the best of their ability. I certify that the participant has full medical insurance with the company listed above. I understand and agree that this document will be kept in the possession of authorized adult team personnel and that reasonable care will be used to keep this information confidential. I agree to allow the authorized adult team personnel to release this information in the event of a medical emergency to a third party medical provider. I also certify to the best of my knowledge that the participant named hereon is physically fit to engage in the activities described above.

Yes

No

Concussion Acknowledgement *

In the past 24 months, have you been tested, diagnosed and/or treated for a concussion:

yes

no

Date Authorized

MM

DD

YYYY

Athlete Signature *

First Name

Last Name

Parent Signature *

First Name

Last Name

Date Signed *

MM

DD

YYYY

COVID-19/ Liability Waiver Release Form 2021 I acknowledge that Horseshoe Hills Christian Volleyball Club, hereby referred to as HHCVC, cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 by participating in this program. I voluntarily attend activities hosted by HHCVC and acknowledge that I must comply with all set procedures to reduce the spread while attending these activities. 1. I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. 2. I have not traveled internationally within the last 14 days. * I have not traveled to a highly impacted area within the United States of America in the last 14 days. 3. I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. 4. I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities. 5. I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I hereby waive on behalf of myself, my child athlete, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of HHCVC, or that may otherwise arise in any way in connection with any services received or activities attended from HHCVC. I understand that this releases HHCVC from any liability or claim that I, my child athlete, or any personal representatives may have against HHCVC with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received or activities attended, hosted by HHCVC. This liability waiver and release extends to HHCVC *

First Name

Last Name

Date

MM

DD

YYYY