Download Click Here for BCVC Club Tryout Packet 2017

BCVC Club Registration Form Packet
THIS PACKET MUST BE COMPLETED IN ITS ENTIRETY (WITH REQUESTED
ATTACHMENTS) IN ORDER FOR YOUR PLAYER TO BE ELIGIBLE FOR
TRYOUTS
 Copy of Birth Certificate (REQUIRED – Prior to Tryouts – even if you are a returning player
– this will expedite the registration process)
 2016 Exp. USAV Card: (Please Circle) Brought Copy or USAV Card Number:
______________
 USAV Medical Release (THIS FORM MUST BE NOTARIZED) – and the notary must witness
the signature of the parent completing the form. If you need the form notarized at tryouts, a
notary will be available, however, please have the form completed BEFORE signing in order
to expedite the registration process.
 BCVC Waiver of Liability Form – BCVC Release Forms (Athlete/Parent Conduct and
Player/Parent Agreement)
 Try-Out Fee
 Dues/Fee Agreement and Financial Agreement Forms
 First Payment of $350.00
OFFICE USE
Try-Out #: _______________ USAV Age Group:_____________ Sibling Playing: Y or N Try-Out Fee: $25.00
Ck. # _____________ Cash Visa MC D PAYPAL
Comments:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Player’s Name: ___________________________________________________________
Player’s Cell Phone: _______________________________________________________
Player’s Date of Birth: _____/______/______
Age: __________
School: ______________________________
Grade Level: ________
Have you played at BCVC before? YES or NO
Volleyball Experience:
___________________________________________________________________________________
___________________________________________________________________________________
Preferred Position: Setter / Libero / Defensive Specialist / Outside Hitter / Right-Side Hitter / Middle /
Undecided
Second Choice Position: Setter / Libero / Defensive Specialist / Outside Hitter / Right-Side Hitter / Middle /
Undecided
Parent/Guardian Name (primary contact):___________________________________________________
Home Address: ______________________________________________________________________
Parent/Guardian Email Address:
________________________________________________________________
Parent/Guardian Phone Number: __________________
Cell Phone Number ____________________________
Parent/Guardian Employment: ___________________________
Work Number: ________________________
Occupation: ________________________________________________________________________
In Case of an Emergency, please list the following people whom are allowed to be notified or pick-up your
child from volleyball events, practice, or tournaments.
1) Name:_________________________ Relation: _________________Phone Number:__________________
2) Name:_________________________ Relation: _________________Phone Number:__________________
BCVC Release Forms
Athlete’s Code of Conduct
1. Athletes are expected to be committed to this program and remain respectful
to their coaches and teammates.
2. Players are responsible for notifying coaches of absences – please try to do so
in advance so coaches can adjust practice plans.
3. Academics, studying and school are priority.
4. Players will notify coaches of any tournament conflicts (at least one month)
prior to the event.
5. No player, parent, or coach shall make any disparaging remark or gesture
regarding another player, teammate, opposing team, coach, official, or parent.
6. BCVC has a NO tolerance policy for alcohol consumption, smoking, or drug
abuse and all players will reframe from such usage.
I have read and understand the above Athlete’s Code of Conduct. I agree that
any violation of the codes will cause expulsion from the club with no refund of
already paid club dues.
Athlete’s Signature: _______________________________ Date:
_____/______/______
I, ____________________________ (parent name), have read and understand
the above Athlete’s Code of Conduct. I agree that any violation of the codes will
cause expulsion from the club with no refund of already paid dues.
Parent Signature: ______________________________ Date:
_____/______/______
The Parent’s Code of Ethics
The club does not require that parents attend a comprehensive orientation program;
however, we do require that all parents complete a Parent’s Code of Ethics form to pledge
their cooperation as follows:
1. I will encourage good sportsmanship by demonstrating positive support for all players,
coaches, and officials at every practice, tournament, and sport event.
2. I will place the emotional and physical wellbeing of my child ahead of personal desire to
win.
3. I will insist that my child play in a safe and healthy environment.
4. I will support coaches and officials working with my child, in order to encourage a positive
and enjoyable experience for all.
5. I will demand a sports environment for my child that is free of drugs, tobacco, and
alcohol. I will refrain from their use at all youth sports events.
6. I will remember that the game is for the youth and not the adults.
7. I will ask my child to treat other players, coaches, fans, and officials with respect,
regardless of race, sex, creed, or ability.
8. I will promise to help my child enjoy the youth sports experience by doing whatever I can;
such as, being a respectful fan and providing transportation.
9. I will require that my child’s coach be trained in the responsibilities of being a youth
sports coach and that the coach holds the Coaches Code of Ethics.
Mother/Guardian (printed):_______________________________________
Mother/Guardian (signature): _____________________________________
_____/_____/______
Father/Guardian (printed): _______________________________________
Father/Guardian (signature): _____________________________________ Date:
_____/_____/_____
Date:
Photo Release
I grant BCVC the right to take photographs of me and my family in
connection with volleyball events; such as, camps, practices, and
tournaments. I authorize BCVC its assigns and transferees to copyright
use and publish the same in print and/or electronically. I agree that BCVC
may use such photographs of me with or without my name and for any
lawful purpose, including: purpose, illustration, advertising, media
release, and web content. I have read and understand the above.
Player’s Name: _____________________________________________
Player’s Signature:
_____________________________________________
Parent/Guardian Name:
_____________________________________________
Parent/Guardian Signature:
_________________________________________
Date: ______/______/_____
Address:
__________________________________________________________
_______, FL _____________
Juniors Participant Waiver of Liability Release
Participant of BCVC I acknowledge that volleyball or any sporting event is an extreme test of a person’s physical and
mental limits and that my participation in volleyball event can cause potential or serious injury or even personal
property damage.
With full understanding of such risks, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown,
EVEN IF ARISING FROM THE NEGLIGENCE OF THE NAMED PERSON OR ENTITIES listed below or others, and assume full
responsibility for my participation. I hereby take the following action for executors, my administrators, heirs, next of
kin, successors, assigns and myself:
A. I WAIVE, RELEASE AND DISCHARGE from any and all claims or liabilities for death or personal injury or damages of
any kind which arise out of or relate to my traveling to and from or my participation in any volleyball event.
B. I AGREE NOT SUE any of the named persons or entities listed below for any of the claims or liabilities that I waived,
released, or discharged herein
C. I INDEMINIFY AND HOLD HARMLESS the named persons or entities mentioned below from any claims made or
liabilities assessed against them as a result of my actions. NAMED PERSON OR ENTITIES: BCVC and their Regional
Volleyball Associations, tournament director, club director, sponsors, board members, officers, employees,
representatives and the owners, and any of the above.
______________________________________________
Printed Player (participant) Name
_____________________________________________ ______________
Players Signature
Date if player is under 18 years of age, a parent or guardian must execute, in addition to the forgoing Waiver/Liability
Release Form, the following, for and behalf of the minor. The undersigned parent and natural guardian or legal
guardian of the player executes the forgoing Waiver/Liability Release Form for and behalf of the minor named herein.
I hereby bind myself, the minor, and all other assigns to the terms of the Waiver/Liability Release Form. I represent
that I have legal capacity and authority to act on behalf of the minor named herein, and I agree to indemnify harmless
named persons or entities named in the waiver/Liability Release Form for any Claims and Liabilities assessed against
them as a result of any insufficiency or legal capacity of my authority to act for and behalf of the minor in the
execution of the Waiver/Liability Form.
___________________________________________ Printed Name of Parent/Guardian
__________________________________________ ______________ Parent/Guardian Signature Date
DUES AND FEE AGREEMENT
The following dues/fees will be applicable for the 2015-2016 BCVC Volleyball Season
rox Teams: $1,700.00 plus uniform
Parent Initials:_________
17 rox teams: $1.650.00 plus uniforms
Parent Initials: _________
18 rox teams: $1,600.00 plus uniforms
Parent Initials: _________
BCVC team$1,320.00 plus uniforms
Parent Initials: _________
Please indicate above which skill level your player is willing to be selected by initialing next to your desired skill level;
if you select ALL skill levels (if applicable), please be aware of the fees associated with each skill level.
At the time you are notified of the team selection (skill level) that your player is chosen for based on his/her tryout,
you may choose a different skill level that you feel may be more appropriate for your player, OR you may accept your
Player’s team selection.
Once your player confirms his/her spot on a team at said designated skill level, you are at that time agreeing to the
dues and fees indicated above for said designated skill level/team selection. In addition, by signing this Dues and Fee
Agreement, and acknowledging the fess and terms herein stated, you are acknowledging that if payments are not
made according to the completed Financial Agreement attached in this registration packet, your account will be
subject to collections.
Parent Signature: _______________________________________
Parent Printed Name: ____________________________________
Date: _________________________________________________
FINANCIAL AGREEMENT
The undersigned hereby agrees to the following payment/financial arrangements for the BCVC Volleyball
2016-2017 Season:
rox Team: $________________
rox 17 team: $________________
rox 18 team: $________________
BCVC team: $ _________
PLAN A PAYMENT TO BE PAID IN FULL: ______ (Please Initial)
*To be made prior to Player’s first practice.
Plan B PAYMENT PLAN METHOD: ________ (Please Initial)
There are two options for plan b, which are:
Option #1 (4) post-dated checks. These will be deposited on the week they are due.
________ (please initial)
Option #2 (4) equal installments applied to the following debit/credit card (please note a
3.0% processing fee will be applied to each installment payment)
________ (please initial)
Option #3 (4) Automatic PAYPAL Payments. These will come out of your account the same
day each month.
DEBIT/CREDIT CARD TYPE: Visa MasterCard American Express / Discover DEBIT/CREDIT CARD
NUMBER: ______________________________
Expiration Date: ________________
CVC #:______________________ (3 digit # on back of card)
Name on Card: _____________________________________________
*If at any time you need to provide different card information, you may do so; otherwise, the card provided above
will be AUTOMATICALLY charged four (4) equal installments beginning prior to the Player’s first practice and
continuing on the same date of each month thereafter until paid in full.
***PLEASE NOTE: If you choose Method (A) – Full Payment, you will receive a 10.0%
discount on the dues/fees.
Also, if you have more than one Player registered, you will receive a 10.0% discount.
***** PARENT SIGNATURE: ____________________________________
DATE: _____________
PARENT PRINTED NAME: _________________________________
***IF AT ANY TIME PAYMENTS ARE NOT ABLE TO BE PROCESSED, YOU WILL BE GIVEN
SUFFICIENT TIME TO RESOLVE YOUR PAYMENT; IF PAYMENT IS NOT RESOLVED, THE PLAYER
WILL BE SUSPENDED FROM PRACTICES AND TOURNAMENTS UNTIL PAYMENT IS MADE.