13U-14U, 2024 Second Chance Spring Beach Volleyball Registration and Medical Release Form
Event: May 12, 15, 17, 19, 22, 24, 29, 31, June 2, 5 / 6:15PM-7:45PM
Location: Venice Beach, 101 The Esplanade W, Venice, FL 34285

All athletes much have an AAU membership to participate in beach volleyball; the cost of an AAU membership is $20. Visit www.aauvolleyball.org and click on 'JOIN.' Enter the Jellys Volleyball club code: RSYYDBT5

**Full payment of $250 for 10 practices is due prior to participation. Payment can be completed via the Zelle App to Jellys Volleyball, LLC (941-726-1600), or via check. Checks can be mailed to: Jellys Volleyball, 327 Dorchester Dr., Venice, FL 34293. Please denote the name of the athlete in the memo field.**
Please email info@jellysvolleyball.com with any questions.


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Email *
Athlete Last Name *
Athlete First Name *
Athlete Street Address *
Athlete Date of Birth (MM/DD/YYYY) *
Please review the USA Volleyball Player Age Definition Sheet in order to determine the athlete's proper age division. Even if the athlete is (ex.) 13 years old, they may fall under the 14U division. Please review the age definitions carefully and select the athlete's proper age division below. *
All athletes much have an AAU membership to participate in beach volleyball; the cost of an AAU membership is $20. Visit www.aauvolleyball.org and click on 'JOIN.' Enter the Jellys Volleyball club code: RSYYDBT5

AAU Membership Number: *
Select athlete tank top size: *
The participant has my permission to participate in the AAU Volleyball Program. I certify that the participant has full medical insurance with the company listed below and is physically fit to engage in the activities of the program. I approve the leaders and coaches of this program and recognize that they will serve to the best of their ability.

**Your typed name constitutes a legally binding signature**
Parent/Guardian Signature:
 *
Date Signed (MM/DD/YYY) *
Relationship to Athlete *
Parent/Guardian Street Address *
Insurance Company *
Group Number *
Policy Number *
Does this policy cover sports related accidents? *
I recognize that all sports, including volleyball, pose a risk of physical injury to the participants, If my daughter/son should become ill or sustain injury during their activities of the volleyball program, I hereby authorize you to obtain emergency medical/dental care for which I will pay, including emergency transportation costs.

**Your typed name constitutes a legally binding signature**
Parent/Guardian Signature:
 *
Date Signed (MM/DD/YYY) *
I understand that full payment of $250 for 10 practices is due prior to participation. Payment can be completed via the Zelle App to Jellys Volleyball, LLC (941-726-1600), or via check. Checks can be mailed to: Jellys Volleyball, 327 Dorchester Dr., Venice, FL 34293. Please denote the name of the athlete with payment. *
A copy of your responses will be emailed to the address you provided.
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