Shore Volleyball Academy - Winter Club Alternative Program Registration Form
Payment will be required for this registration to be confirmed and to save your athlete's spot in the program.

A response email may take up to 5 business days days upon completion of this form.
Email address *
Athlete Name: *
Program: *
Those wishing to select a select a session with older athletes must email me at to get approval- or you will be moved to your appropriate aged session.
Parent/Guardian Name: *
Street Address *
City: *
State: *
Zip Code: *
Birthdate: *
Grade in 2019-20? *
Should the athlete be restricted from athletic activities in any way? You must include any medical conditions that would require restricted participation. Must write "None" if so. *
Parent Cell Phone #: *
Secondary Email Address
T-Shirt size: *
What school does the athlete attend this 2019-20 academic year? *
Does the athlete currently play for a volleyball club? If so, which club?
What is the primary position?
Clear selection
What is the secondary position?
Clear selection
How many years of past VB experience does the athlete have? *
How did you hear about this program? *
I hereby give permission for my child to participate in this 2019-20 Shore Volleyball Academy Program. I certify that they are in good physical condition, have been examined within the last 12 months, and no medical reason has been found that they cannot participate in this program. Records show that all immunizations are up to date. I understand that they will be participating in rigorous play and activity. Clinic personnel have also been informed of any physical limitations, medications, or prior conditions. The program will safeguard the health of my child, but will not be responsible for accidents, injuries, or sickness on the way to volleyball, during volleyball, or on the way home. I agree that in the case of an accident involving my child while attending this program, and with full awareness that volleyball is an activity that may involve risk or injury, I release Dan Sempkowski, Shore Volleyball Academy, all the coaches, and host sites from any and all liability. I hereby request that my child be granted admittance into the 2019-20 Shore Volleyball Academy Clinic and authorize the directors to act on my behalf in the event of an emergency requiring medical attention. I will assume responsibility of payment for any such attention and have provided all necessary information. *
Parent please initial in agreement of the above statement. *
Please select a payment option: *
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