Youth Camp Registration

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Player's Name*

First Last

Birthdate*

Please choose the appropriate session

Years of Experience*

Parent's Name*

First Last

Address*

Street Address City State ZIP Code

Phone*

Alt Phone

Email*

Player Fee

Parent Permission and Authorization WAIVER Form*

I, the undersigned, do hereby certify that I shall assume all financial responsibility for any injury to the above named player. I waive, release, absolve, indemnify, and agree to hold harmless Centerline Volleyball, it’s referees, coaches, participants and persons included in all league activities, for any injury, transporting to and from those activities to include participation, from all claims or liability directly or indirectly for any claim arising out of injury to the player or myself. I certify that I have my own insurance.
If I, the undersigned, cannot be reached in the event of an emergency, I also give consent for the league directory, referees or coaches to obtain through a physician or a hospital of its choice, such medical care as is reasonably necessary for the welfare of the player.

I Agree

Credit Card- $60/player*

American Express

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Card Number

Expiration Date

Security Code Cardholder Name

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