Please fill out this one-time participant information and liability form. Thank you!

Participant First name

Participant Last name

Participant Birthday

Month

Day

Year

Who is the main person we should contact? Provide name and relationship to participant

Main Contact Email

Yes, subscribe me to your email list.

Main Contact Phone

Address

Participant School (if applicable)

Gender

Female

Male

Other

Please Check any conditions the participant currently has or has had in the past:

Please add detail if you checked any box above

Current Medications:

Allergies:

Date of Last Tetanus Shot

Does Participant Require an EpiPen?

yes

Relevant injury, health, or dietary history or restrictions:

Hospital of Choice

Physician's Name

Physician's Phone number

Emergency Contact Name and Relationship #1

Emergency Contact Phone Number #1

Emergency Contact Name and Relationship #2 (optional)

Emergency Contact Phone Number #2 (optional)

Media Release

Yes, I consent

No, I do not consent

I give permission to Sandblazers Volleyball Club LLC to use photographs, video recordings, or digital images of me or my child for promotional and marketing purposes, including social media, websites, and print materials. No personal identifiers will be used without additional permission.

LIABILITY WAIVER AND ASSUMPTION OF RISK

By typing my full legal name below and submitting this form, I acknowledge and agree that: (i) I have accessed, read, and understand the Liability Waiver and Assumption of Risk available at the link provided above (the “Waiver”); (ii) I agree to be bound by the Waiver in its entirety on behalf of myself and, if applicable, each minor identified in this form; and (iii) my typed name constitutes my electronic signature and has the same legal effect as a handwritten signature.

I represent and warrant that I am at least eighteen (18) years of age. I understand that the Waiver contains a release of liability and assumption of risk, and that by signing I am voluntarily giving up substantial legal rights, including the right to bring a lawsuit or assert claims against the released parties.

I am signing this form on behalf of myself and, if applicable, each minor identified in this form. To the extent I am signing on behalf of any such minor, I represent and warrant that I am the parent or legal guardian of such minor(s), that I have full legal authority to execute the Waiver on their behalf, and that I consent to their participation in the applicable programs and activities. I further agree, individually and on behalf of such minor(s), to all terms of the Waiver, including the release of liability and assumption of risk provisions.

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Any other relevant information you wish to disclose?