Summer Volleyball Clinic Registration 2023

VB clinic

Registration Fee : $100 per athlete

*The clinic requires a minimum of 12 participants and will be capped at a maximum of 28. Once we have 28 registered we will start a waiting list.

Registration Deadline: Wednesday, June 28th

Registrations received after the deadline subject to a $25 late fee and will not receive t-shirt.

The clinic is for 9th through 12th graders (grade entering Fall 2023).

The clinic will be run by coaches from the North Jersey Volleyball Club.

This form MUST be completed for each participant and payment must be made before the start of the Volleyball Clinic. No exceptions.

Clinic Details

Volleyball Clinic

Monday July 10th through Thursday July 13th (4 days)

7pm-9pm

MHC Gymnasium

Student Information

Full Name:*

Answer Required

Entering Grade:*

Fall 2023

Answer Required

Birthdate:*

Answer Required

Cell Phone:

No dashes or symbols

Answer Required

Address

Street Address:*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Home Phone:*

Answer Required

Parent/Guardian Information

Primary Parent/Guardian Name:*

Answer Required

Primary Parent/Guardian Email:*

Answer Required

Primary Parent/Guardian Cell:

Answer Required

Secondary Parent/Guardian Name:

Answer Required

Secondary Parent/Guardian Email:

Answer Required

Secondary Parent/Guardian Cell:

Answer Required

Emergency Contact Name:*

In the event either parent cannot be reached.

Answer Required

Emergency Contact Number:*

Answer Required

Health Insurance Information

Insurance Provider:*

Answer Required

Policy #:*

Answer Required

Company Address:*

Answer Required

Phone:*

Answer Required

Are there any medical conditions/allergies that we should be aware of?*

Examples: Asthma, Carries an Epi-pen for Severe Allergies, Seizures, etc.

Answer Required

Yes

If yes, please explain below.

Answer Required

Medical Treatment Authorization and Liability Release

My daughter elects to take part in the Mary Help of Christians Academy Summer Volleyball Clinic. I acknowledge that this is an extracurricular activity in which my daughter is participating voluntarily and understand that there may be some risks of illness or injury (minimal, serious, or catastrophic) in connection with the activity itself and/or transportation to and from the activity. In consideration of my daughter being permitted to participate in the activity, I hereby assume all of these risks and waive any possible claim that my daughter or I might have against Mary Help of Christians Academy athletic programs, Mary Help of Christians Academy, the North Jersey Volleyball Club and any employees, agents, or students, in conjunction with our participation in this activity. I further acknowledge that the above individual is covered by health insurance. I hereby agree that I am responsible for all medical treatment, and give permission for my child to receive medical treatment in the event that I am unable to be contacted. I hereby hold Mary Help of Christians Academy & NJVC and its coaches and their directors and representatives harmless in exercise of this authority. I also give permission for Mary Help of Christians Academy to use photographs taken of my child at the clinic to post online or use of future posters.

I acknowledge that have read and understand the medical treatment & liabilty release statement contained herein and give consent.*

Answer Required

Parent must click here.

Enter Full Name as Signature:*

Answer Required

Date*

Answer Required

Payment*

Clinics can be paid by check made out to MHCA, cash in sealed envelope with name or VENMO @MHCA-Athletics (3313) .

Answer Required

Check

Cash

VENMO

T-Shirt Size*

Shirts will only be ordered if at least 12 athletes have registered for the clinic by the deadline.

Answer Required

Adult Small

Adult Medium

Adult Large

Adult XL

Adult 2XL

Other:

Please fix the highlighted areas below before submitting.

Summer Volleyball Clinic Registration 2023