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					                  Volleyball Clinic Registration Form

Camper’s name: _________________________
Address: _______________________________________________
Phone: ___________________ Email: ________________________
School: __________________ T-Shirt Size: _______________

Medical Release:
All campers must have their own medical coverage. Camper will not be allowed to participate
unless the following information is submitted and a copy of an updated physical is on file
with Clinic Director.

Camper’s Insurance Company ________________________________
Address __________________________________________________
Phone __________________            Policy # ______________

I/We, the undersigned, hereby certify that I (we) am (are) the parent(s) or legal
guardian(s) of the camper. I hereby give permission for the staff of raw volleyball clinics to
seek during the period of the clinic appropriate medical attention for the camper and for
the medical attention to be given and for the camper to receive medical attention in the
event of accident, injury, or illness. I (We) will be responsible for any and all costs of
medical attention and treatment.

Waiver Statements
I/We hereby acknowledge and understand that the raw volleyball clinics are sponsored and
run by the Mount Tabor High School Athletic Boosters. The clinic, while conducted by raw
volleyball, is under the sponsorship and administration of the MTHS Athletic Boosters.
I/We waive, release and forever discharge Mount Tabor High School Athletic Boosters and
raw volleyball and its staff, officers, agents, employees and/or representatives from any
and all liability, claims, demands, actions, and causes of actions whatsoever arising out of or
related to any loss, personal injury and/or property damage sustained during participation in
clinic activities or while attending clinic.

____________________________________________                         _______________
Parent/Guardian Signature                                            Date

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