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Summer Youth Volleyball Camp

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					 Please be at the high school gym between 4:00 and
  4:15 on July 18th to register for the camp. Checks can
  be made out to PSHS Volleyball.
 Parents/Guardians must fill out a waiver before girls
  may participate.
 A Volleyball T-Shirt will be given to all participating girls.
 This is a fundraiser for the high school volleyball
  program. We use the money to attend summer team
  camps.
 If you have any questions, please contact Coach
  Connie Sue O’Donnell at 946-1607
Pagosa Springs Youth Volleyball Camp 2011
WAIVER, RELEASE, ASSUMPTION OF RISK, AND INDEMNIFICATION AGREEMENT



Participant Name: __________________________________________
In consideration of Archuleta County School District and Pagosa
Springs High School granting me permission to participate in the
above-referenced event, and with the understanding that such
participation is conditioned upon my execution of this waiver
and release, for myself, my heirs and assigns, I hereby
acknowledge, recognize and assume the risks involved in the
event and any risks inherent in any other activities connected
with the event in which I may voluntarily participate. I
expressly assume the risk of and accept full responsibility for
any and all injuries (including death) and accidents which may
occur as a result of my participation in the and release from
liability Archuleta County School District, Pagosa Springs High
School and its employees.

THIS IS A RELEASE OF LIABILITY. The SIGNATURE OF A PARENT OR
LEGAL GUARDIAN IS REQUIRED. I HEREBY CERTIFY THAT I HAVE READ
AND FULLY UNDERSTAND THIS WAIVER, THE RISKS, AND RELEASE THE
ABOVE MENTIONED FROM LIABILITY.


_______________________________________________________
Signature of Participant                Date



_______________________________________________________
Signature of Parent                     Date



_______________________________________________________

Number where parent/guardian can be reached


_______________________________________________________

Emergency Contact information

				
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