(Mail completed form with fees) Elementary School Fall VB League Pre‐registraĕon and payment is required to parĕcipate. To register: Email Adrienne Delph, [email protected] or mail this completed form with fees. Registraĕon deadline: Sept. 9, 2016 Checks payable to : Power VB Send to : Power Green Bay 807 Parkview Rd. Ashwaubenon, WI 54304 (complete the information below and return with payment) Player First Name:____________________ Last Name: ____________________ Grade: ____ Parent E‐mail: ______________________________________________________________ Player Cell #: ______________________ Parent Cell #: ____________________________ 2016 4LV, Inc. / WI PoWer VBC Liability Waiver I, the undersigned, have adequate insurance and am/are willing to take full financial responsibility for any and all injuries sustained by my son/ daughter/legal ward, ____________________, while parĕcipaĕng in camp/clinic/league acĕviĕes. I further knowingly and voluntarily waive any and all claims against and forever release the camp/clinic/league, its employees, 4LV, Inc. Sports Advantage Center, and WI PoWer VBC. My insurance carrier is ______________________PolicyNumber_________________ Emergency Contact ______________________Phone Number _________________________ My signature below will allow a coach or designated person to admit my son/daughter/legal ward to a medical facility and/or to the care of a physician, if condiĕons warrant such acĕon. First noĕficaĕon will be to the emergency contact listed above. Check here [ ] if you would like to be excluded from our email list for future events and acĕviĕes. Parent / Legal Guardian Signature _____________________________________Date _______________