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I, the undersigned, 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:

  • I 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 2005.

Name ___________________________________________________________________________
Address ___________________________________________________________________________
City __________________________________________   State   _________   ZIP   ___________
Phone # (_____) _____ - ____________   Work   (____) _______ - ______________
E-Mail _____________________________________   Age   _______   Gender     M     F
 
Signature________________________________________________   Date ___/___/______
Guardian
Signature
________________________________________________   Date ___/___/______

JSVBA use only: Membership Number # __________________________