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Membership, Waiver and Release Form
I agree, as consideration for the acceptance of my participation in
events conducted by the Jersey Shore Volleyball Association (JSVBA),
to absolve and hold harmless the JSVBA and any and all others
involved and that I, and all parties on my behalf, agree that we will
not sue the JSVBA or any others involved as a result of the operation
of or my participation in any JSVBA event. I assume full
responsibility for any risk occurring from my participation. I assert
that I have no physical condition that would preclude my
participation. I understand that participation in a JSVBA event
construes my acceptance of the risks inherent in such activities
including, bodily injury, death, property damage, and any and all
other risks. I assert that I have accident/health insurance coverage
that will apply in the event of injury as a result of my
participation. I consent to and will permit emergency treatment if
required. I assert that I am of legal age to contract or that my
legal guardian has read and signed this release and waiver. I assert
that I will inspect the playing area and agree that my participation
signifies that it is free of hazards. I give permission to use my
name and likeness for promotion. I accept the complete responsibility
for the payment of any taxes that may be due any government agency
for any money or merchandise that I may receive as a result of my
participation. This waiver, release, and agreement applies to any and
all JSVBA events that I may participate in during 2002.
Name________________________________________________________________________________
Address______________________________________________________________________________
City _____________________________________________ State _________
ZIP ___________
Phone # Home (_____) _____ - ____________ Work (____) _______ - ______________
E-Mail _____________________________________ AGE _______ Gender M F
Signature ________________________________________________
Guardian Signature ________________________________________________ |