* 1. Player Name:

* 2. What is your child's gender?

* 3. What is your child's birthday?

Birthdate

* 4. Parent Name

* 5. Parent Email

* 6. Parent Phone

* 7. Select Child's Playing Experience

* 8. Waiver & Release of Liability

I understand that there are risks involved with my child’s participation in the LAPVC Volleyball Club competitive soccer tryouts.

I hereby authorize the directors of Los Angeles Premier Volleyball Club, ("LAPVC") to act for me according to their reasonable judgment in any emergency requiring medical attention. I hereby waive and release the directors of LAPVC from all liability and agree to accept all medical expenses incurred. I know of no physical or mental problem that will affect my child’s ability to safely participate in these tryout sessions. I acknowledge and accept the conditions above with my signature below.

I certify that my child is in good health, and may participate in strenuous physical activities at the tryouts. I certify that there are no physical limitations to my child’s participation in the tryout. Permission is granted for my child to receive emergency medical treatment if needed. I hereby release and forever discharge LAPVC and all their agents, employees and affiliated entities from any and all liability, claims, demands, and cause of action for personal injury or death, property damage, and/or other loss suffered by my child in connection with his/her participation in the tryouts. I acknowledge and accept that this Release and Waiver is intended to be binding on the family, estate, heirs, executors, administrators and assigns of the minor named above. I further acknowledge and accept that this Release and Waiver is intended to be as broad and inclusive as permitted by the laws of California and agree that if any portion of this release and Waiver is invalid, the remainder will continue to be in full force and effect. I agree that this Release and Waiver binds the minor and me to all of its terms.

I hereby grant permission to LAPVC and its legal representatives, assigns, and those acting on its behalf, to use any picture, video or audio recording of my child taken in connection with the tryouts for all manner of advertising, trade, promotion, exhibition, or any other lawful purpose related to youth soccer whatsoever and in any form or medium.

I hereby release the LAPVC. and the SCVA, its member leagues, teams, agents, officers, coaches and players from all liability or responsibility for any claim, damage or legal action on behalf of the player or the player’s parents, heirs, or personal representatives, arising from any injury the player may sustain while participating in soccer or related activities, including transportation, except to the extent and in the amount covered by the SCVA accident reimbursement plan.

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