Junior Fillies

Junior Fillies

Panola Volleyball is looking forward to hosting our second annual Junior Fillies Volleyball Club! To join please complete the waiver and registration form below.

 

Panola Volleyball Junior Fillies 

 

Liability and Waiver: By signing below, I approve the participant’s attendance during the Junior Fillies program and certify that she is in good health and able to participate in all activities.  In case of an accident, injury and/or illness, Panola coaches, administration, athletic trainers, and any other medical personnel have my permission to use their best judgment in the care of my child.  I fully understand that in the event of an accident, injury or illness that the clinic attendee’s insurance policy listed below will be used for coverage.  ___________________________(Parents Name) agree(s) to indemnify and hold harmless Panola College, its board of directors, employees, and staff from and against every expense, including attorney fees, liability or payment by reason of any damages or injury to my child arising out of or in connection with the activities held on these premises, facilities, or equipment, provided that such damage or injury are NOT caused in whole or in part by Panola College, its board of directors, agents, employees, staff, or participants. 

 

____________________________________Parents Signature          _______________________________Date

Insurance Information

Printed Parent/Guardian Name:                                                                                                                                                            

Signature                                                                                                                                                Date                                                

Insurance Company                                                         Policy number                                            Primary Insured:                                       

Emergency Contact Name:                                                                                    Contact Number:                                                    

Medications/Medical Conditions or Allergies:                                                                                                                                        

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T-shirt Size:  Youth:   L    Adult :  S   M   L  XL                          Participant’s Age:                                                  

Participant Name:_                                                                                ___________________Grade  2017/18 School Year:                           

Address: ___________________________________                                                                                                                                           

                Street                                                                       City                                          State                                         Zip

Parent/Guardian Names:                                                                                                                                                                                                                       

Printed Names

Contact numbers:                                                                                                                                                                                   

                                Parent Cell                                              Parent Work                                           Participant Cell

 

 Parent Email: