2023 - 2024 SCVA Letter of Commitment & Medical Release – Junior Girls - Post Tryouts

Welcome to the 2023-2024 SCVA Season. Please take the time to carefully fill out all required fields.

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SCVA Letter of Commitment – Junior Girls

Club Name - Select from Drop Down- if club is not listed they are not currently sanctioned for the 2023-2024 season*

Type in Club Name to Confirm*

Team Name

Player's Name*

First Name*

Last Name*

Birth Date*

https://scvavolleyball.formstack.com/forms/images/2/calendar.png

Month

Day

Year

Age*

Sex*

Female Male

Other: Other Value

Primary Contact: Parent or Guardian

Parent's/ Guardian's Name -Primary*

First Name*

Last Name*

Relationship to Player*

Mother Father

Other: Other Value

Primary Phone #*

Alt Phone #

Parent's/ Guardian's Primary Email*

Confirm Parent's/ Guardian's Primary Email *

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Would you like to provide a secondary contact?*

Yes No

Secondary Contact

Parent's/ Guardian's Name - Secondary*

First Name*

Last Name*

Relationship to Player*

Mother Father

Other: Other Value

Primary Phone #*

Alt Phone #

Parent's/ Guardian's Secondary Email*

Confirm Parent's/ Guardian's Secondary Email *

Address - Secondary

Address Line 1

Address Line 2

City

State

ZIP Code

DO NOT SIGN FOLLOW-UP EMAIL DOCUMENTS WITHOUT READING CAREFULLY. ALSO, DO NOT SIGN PRIOR TO 8 AM on JULY 23, 2023 (15-18&UNDER AND ALL HIGH SCHOOL AGED PLAYERS) OR OCTOBER 1, 2023(14&UNDER).

This requirement has been created to protect the player and parent/guardian as a member of a club.

Basic Penalty. I understand that by signing this letter, I am committed to joining the club named with this document for the entire 2023/2024 season. If I compete for another club, I may be subject to suspension for the remainder of the season.
- Early Signing Period. A player who signs a Commitment Form before 8 AM on JULY 23, 2023 (15-18&under AND ALL HIGH SCHOOL AGED PLAYERS) or OCTOBER 1, 2023(14&under) is subject to suspension for the entire season. A club representative may not ask a player to sign prior to 8 AM on JULY 23, 2023 (15-18&under AND ALL HIGH SCHOOL AGED PLAYERS) or OCTOBER 1, 2023(14&under) either.
- Under no conditions may the Commitment Form be pre-signed or pre-dated before this time frame. In turn, no deposit monies, team or club fees can be collected before JULY 23, 2023 (15-18&under) or OCTOBER 1, 2023(14&under). A player may not sign a Commitment Form before JULY 23, 2023(15-18&under AND ALL HIGH SCHOOL AGED PLAYERS) or OCTOBER 1, 2023(14&under) regardless of the date of the tryout. A player who signs a Commitment Form or a club that allows a player to sign at a tryout date prior to July 23^rd (15-18&under) or OCTOBER 1^st(14&under) is subject to suspension for the entire season.
- Only one Commitment Form is permitted. A player who signs more than one Commitment Form with more than one club is subject to suspension for the entire 2023/2024 season.
Verbal Commitments. A player may commit verbally to a club prior to JULY 23, 2023 (15-18&under AND ALL HIGH SCHOOL AGED PLAYERS) or OCTOBER 1, 2023(14&under). A verbal commitment is not binding. The player may revoke the commitment at any time, before signing the Letter of Commitment, without penalty.
Once the Commitment Form is signed and turned into one club, the player is then committed to that club. If a player does not follow the tryout procedures and commitment date, she may be suspended for the 2023/2024 season.
Recruiting Ban after Signing. I understand that all clubs are obligated to respect my signing and shall cease to recruit me upon my signing this document. I shall notify any recruiter who contacts me that I have signed.
Parent/Guardian Signature Required. My parent, or legal guardian, is required to sign this Commitment Form if I am less than 18 years of age at the time of signing.
Falsification of Letter of Commitment. If I falsify any part of this Commitment Form, including the date, I understand that I am subject to suspension for the entire 2023/2024 season.
Nullification of Other Agreements. My signature on this Commitment Form nullifies any agreements, verbal or otherwise, which would release me from the conditions stated within this document.
Binding Agreement. I understand that I have signed this Commitment Form with the club and not with a particular individual. If the coach or any player(s) leave the team, I remain bound by the provisions of this document for the entire 2023/2024 season. I certify that I have read all terms and conditions in this document. I have discussed them with the club representative named within, and I fully understand, accept, and agree to be bound by them

Youth and Junior Volleyball Player Medical Release Form

By signing the follow up documents that will be emailed to me upon submission of this form the participant affirms having read and agreed to the terms and conditions listed below.

My child has my permission to participate in training, competition, events, activities and travel sponsored by USA Volleyball or any of its Regional Volleyball Associations (RVAs). I approve of the leaders who will be in charge of this program. I recognize that the leaders are serving to the best of their ability. I certify that the participant has full medical insurance with the company listed. I understand and agree that this document will be kept in the possession of authorized adult team personnel and that reasonable care will be used to keep this information confidential. I agree to allow the authorized adult team personnel to release this information in the event of a medical emergency to a third party medical provider. I also certify to the best of my knowledge that the participant named hereon is physically fit to engage in the activities described above.

Medical Information

Primary Insurance Co. (if applicable)

Primary Group #

Primary Policy #

Family Physician Name

First Name

Last Name

Physician Phone #

Emergency Contact Number*

Are there medical conditions of which we should be aware?*

Yes No

Please elaborate on any medical conditions of which we should be aware*

Are there medications currently being taken?*

Yes No

Please list any medications currently being taken*

Does the participant have any known allergies?*

Yes No

Please list known allergies*

If None, please write None.

In the past 24 months, have you been tested, diagnosed and/or treated for a concussion*

Yes No

If yes, provide the date (months and year), who performed the testing/diagnosing/treatment and what was the outcome

If, during the course of my child’s activities in volleyball, she/he should become ill or sustain injury,*

I hereby authorize you to obtain emergency medical/dental care. I will assume all financial responsibility for the bills incurred through my insurance company. I hereby do not authorize medical/dental care for my child.

I understand that I will follow up with the email sent by SCVA to complete all electronic signatures required for these forms. *

Yes