Gig Harbor Volleyball Club Release

Gig Harbor Volleyball Club Tryout Consent, Release of Liability, and Medical Authorization Player Name: _______________________ Date: ______________ This is to certify that I, ______________________, parent or guardian of the player named above; hereby grant my permission to the Gig Harbor Volleyball Club (GHVC), GHVC Coaches and/or affiliated GHVC tryout staff, or any member of Harbor Club Sports (UBI 602895862), to obtain emergency medical care from any duly licensed Doctor of Medicine, hospital or medical clinic for my child. This authorization is valid only while the player is away from her legal residence for the purpose of participating in the GHVC 2009-2010 season tryouts. I give my child permission to participate in the GHVC 2009-2010 season tryouts held on or about November 19th, 2009. I, acknowledge that volleyball as any sporting event is an extreme test of a person’s physical and mental limits and carries with it the potential for death, serious injury or property loss. With full understanding of the potential risks, I HEREBY ASSUME THE RISK for participation. Further, I release GHVC, GHVC staff, members of Harbor Club Sports, and Lighthouse Christian School, from any and all claims or liabilities for death or personal injury or damages of any kind. I agree not to sue any of the persons or entities mentioned above for any of the claims or liabilities that have been waived. I indemnify and hold harmless the persons or entities mentioned above from any claims made or liabilities assessed against them as a result of my child’s actions. Light House Christian School is in no way affiliated with Gig Harbor Volleyball Club or Harbor Club Sports. I also certify that my child is covered by a government and/or private health and accident insurance plan. I understand I am responsible for all hospital, laboratory, dental and doctor’s fees. My child is physically fit to participate in vigorous physical activity.

Parents Name: ________________________________Phone #: ________________ Parent’s Signature: ___________________________________ Date: ____________ Emergency Phone #’s ________________________________________ Insurance Company: _________________________ Policy #: ___________________ ID # ______________________