Coaching Liability Waiver

							                                                                         2010 - 2011
                                                   Waiver Liability and Release Form

Athlete's Name
            FIRST                   Middle                Last                 Date of Birth Athlete's E-Mail Address

Athlete's Address
                                                                                       Phone
                                                     City , State, Zip


Athlete's Date of Birth
Grade in Fall 2010
School

Prior Club / School playing                                                        Allergies
experience and position                                                            or Other
                                                                                  Conditions


Guardian Information
Mother's Name                                                                           Cell
Mother's E-mail
Father's Name
Father's E-Mail                                                                         Cell

Waiver and Release
I acknowledge that volleyball or any sporting event can cause serious injury, property damage and death and I hererby WAIVE, RELEASE AND
DISCHARGE Delaware United Volleyball Club and Padua Academy, along with its respective agents, administrators, coaching staff and board of directors
from any and all claims for personal injuries or damages or loss which may arise from the use of Padua's buildings, grounds, and/or facilities.

Guardian Signature
                                  Date



                                                        Tryouts Checklist:
                                             1) DU Waiver and Release Form
                                             2) USAV Medical Release Form
                                             3) CHRVA Membership Card
                                             4) Tryout Fee Check for $20.00
                                             5) Club Deposit Check for $500.00