Insurance Waivers for Players & Staff | Junior Volleyball Association

JVA Insurance Waivers for Players & Staff

It is required that the JVA Insurance Waiver be completed every season by every player and staff member.

"*" indicates required fields

Welcome

You DO NOT need to log in to complete the JVA Insurance Waiver. It is recommended that you complete the waiver from a computer, not a phone. Please direct any questions to your club.

Club Selection

Select Your Club*

Not 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. Check "My Club is Not in the List". You will then need to enter your Club Name.

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*

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:*

format (###) ###-####

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.

Parent/Guardian or Coach Signature*

Parent/Legal Guardian or Coach Signature*

Parent/Legal Guardian or Coach Signature:*

Parent/Legal Guardian Relation to Player

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.

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!

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