Insurance Waivers for Players & Staff

JVA Insurance Waivers for Players & Staff

"*" indicates required fields

Welcome

You DO NOT need to log in to complete the insurance waiver. JVA Participant Release of Liability - This registration session will allow you to complete contact information and sign waivers. Please direct any questions to your club.

Club Selection

Select Your Club*

Not Part of a JVA Member Club?

My Club is Not in the List

If your club is not in the above dropdown list, your club is likely not a JVA member but you still need to complete a background screen and APS Training.

Check "My Club is Not Listed" below. You will then need to enter your club, club director's name and their email to notify them that you've started the background screen process.

Non-JVA Member Club Information

Club Name*

You must enter your full club name. Please do not use any abbreviations.

Contact Information

Club Director Name*

First Last

Club Director's Email*

Are you registering as a coach or registering a player?:*

I am registering as a coach

I am registering as a player

What season are you participating in?:*

Participant Information

(Player or Coach)

Name*

First Middle Last

Date of Birth*

Age*

Are you under 18 Years Old?:*

Under 18

18 or Older

Gender*

Female

Male

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Email Address:*

Your Phone Number:*

Team Name:*

Parent/Guardian Information

If you are a coach, fill in your own information.

Parent/Guardian Name*

First Last

Parent/Guardian Cell Phone*

Parent/Guardian Home Phone*

Parent/Guardian Email*

Parent/Guardian #2 Name*

First Last

Parent/Guardian #2 Cell Phone*

Parent/Guardian #2 Home Phone*

Parent/Guardian #2 Email*

Waiver, Emergency & Medical Contact Information

JVA PARTICIPANT RELEASE OF LIABILITY

In consideration of being allowed to participate in any way in the program, related events and activities, I the undersigned, acknowledge, appreciate, and agree that:

The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist and,
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, BUT NOT GROSS NEGLIGENCE OF THE RELEASES; or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately and,
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE (JVA) Junior Volleyball Association, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (RELEASEES), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19

In consideration of being allowed to participate on behalf of this athletic program and related events and activities, the undersigned acknowledges, appreciates, and agrees that:

Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS (insert name of sports organization) their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Participant Signature (player or coach)*

Release Consent*

I agree

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

Parent/Legal Guardian or Coach Signature*

Consent for Participation*

I agree

Participant has my permission to participate in training, competition, events, activities and travel sponsored by JVA member club. I approve 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 below. I also certify to the best of my knowledge that the participant named hereon is physically fit to engage in the activities described herein.

Parent/Legal Guardian or Coach Signature:*

Parent/Legal Guardian Relation to Player

Consent on Behalf of Both Parents or Coach*

I agree

AS CUSTODIAL PARENT OR COURT-APPOINTED GUARDIAN OF THE PARTICIPANT NAMED ABOVE, I DO FOR BOTH OF CHILD’S PARENTS, FOR CHILD AND CHILD’S HEIRS AND SUCCESSORS, RELEASE JVA, CORP. AND ANY OF ITS AGENTS OR REPRESENTATIVES (ALL OF THE FOREGOING COLLECTIVELY “JVA.”) FROM ALL CLAIMS ARISING OUT OF OR CONNECTION WITH CHILD’S PARTICIPATION IN ANY JVA INSURED CLUB, PROGRAM OR TOURNAMENT. I PROVIDE THIS RELEASE BECAUSE I AM MINDFUL THAT ATHLETICS, PHYSICAL TRAINING AND COMPETITION CAN BE A DANGEROUS UNDERTAKING REGARDLESS OF HOW CAREFUL OR PRUDENT ANY PERSON, FIRM OR FACILITY MIGHT BE.

Medical Release

The following Medical Release/Medical Treatment is not required by JVA. Check with your Club Director if they are requiring the following section to be completed.

Consent for Medical Treatment

I agree

Further, I give permission to JVA insured member club to treat participant or arrange for medical care or treatment for child in any situation deemed reasonably necessary by JVA insured member club. If circumstances permit, JVA member club shall attempt to communicate first via telephone with the following emergency contacts for child.

Emergency Contact Name:

First Last

Emergency Contact Relationship to Participant:

Emergency Contact Primary Phone:

Secondary Emergency Contact Name:

First Last

Secondary Emergency Contact Relationship to Participant:

Secondary Emergency Contact Primary Phone:

Medical Treatment Information

In the event neither emergency contact can be reached; or if the urgency of the situation requires immediate attention without prior telephone contact, JVA insured member club may arrange for medical treatment for the participant at the expense of the parent or guardian signing this form. Health Insurance, PPO information for child is as follows:

Medical Insurance Company:

Medical Insurance Policy Number:

Medical Insurance Company Phone:

Insurance Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

In order to seek appropriate medical care or treatment of Child, please disclose the following:

Allergies (Please specify):

Medical Conditions (Please be specific)

Any other conditions, symptoms or disability, which would or might affect medical care or treatment or participation in the JVA program:

JVA is a proud partner of USSCI, Sports Fee Insurance. Are you interested in receiving more information about protecting your non-refundable club dues?

Yes, I would like more information

Pleave review ALL information before submitting. ONCE AN INSURANCE WAIVER IS SUBMITTED, IT CANNOT BE EDITED!

Name

This field is for validation purposes and should be left unchanged.

JVA Insurance Waivers for Players & Staff

Welcome

Club Selection

Non-JVA Member Club Information

Contact Information

Participant Information

Parent/Guardian Information

Waiver, Emergency & Medical Contact Information

JVA PARTICIPANT RELEASE OF LIABILITY

WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19

Medical Release

Medical Treatment Information

Pleave review ALL information before submitting. ONCE AN INSURANCE WAIVER IS SUBMITTED, IT CANNOT BE EDITED!

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