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Note: Due to significant administration considerations, it is highly suggested that you bring this completed form to your first event and join the JSVBA on-site rather than mail it in advance. Should you prefer to do it by mail then:

If you wish to send in your Membership, Waiver, and Release Form prior to playing in your first event.

Print This Page, Fill Out The Form and mail with a check for $10 to:

1504 Boat Landing Rd.
Pt. Pleasant, NJ 08742

Membership, Waiver and Release Form

I agree, as consideration for the acceptance of my participation in events conducted by the Jersey Shore Volleyball Association (JSVBA), to absolve and hold harmless the JSVBA and any and all others involved and that I, and all parties on my behalf, agree that we will not sue the JSVBA or any others involved as a result of the operation of or my participation in any JSVBA event. I assume full responsibility for any risk occurring from my participation. I assert that I have no physical condition that would preclude my participation. I understand that participation in a JSVBA event construes my acceptance of the risks inherent in such activities including, bodily injury, death, property damage, and any and all other risks. I assert that I have accident/health insurance coverage that will apply in the event of injury as a result of my participation. I consent to and will permit emergency treatment if required. I assert that I am of legal age to contract or that my legal guardian has read and signed this release and waiver. I assert that I will inspect the playing area and agree that my participation signifies that it is free of hazards. I give permission to use my name and likeness for promotion. I accept the complete responsibility for the payment of any taxes that may be due any government agency for any money or merchandise that I may receive as a result of my participation. This waiver, release, and agreement applies to any and all JSVBA events that I may participate in during 2003.



City _____________________________________________ State _________ ZIP ___________

Phone # Home (_____) _____ - ____________ Work (____) _______ - ______________

E-Mail _____________________________________ Age _______ Gender M F

Signature ________________________________________________ Date ___/___/2003

Guardian Signature ________________________________________________ Date ___/___/2003

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