Waiver for Bettendorf League

Release, Waiver, and Hold Harmless Permission to Participate
THE CITY OF BETTENDORF REQUIRES THIS FORM BE SIGNED BEFORE PARTICIPATION
IN A CITY SPONSORED ACTIVITY. IF THIS FORM IS NOT SIGNED, YOU OR YOUR CHILD WILL NOT BE
ALLOWED TO PARTICIPATE. IT IS A WAIVER OF RIGHTS.
DO NOT SIGN IF YOU HAVE ANY QUESTIONS.

1. You, for yourself and as appropriate on behalf of your child hereby agree to release, waive, and hold harmless the City of Bettendorf, the Bettendorf Community School District, agents, employees, volunteers, and contractors of either entity (Collectively referred to as “RELEASEES”) from any and all liability arising from participation in the activity you are registering for or signing a roster for.
2. This release waives all claims whatsoever, known or unknown, which may arise by virtue of participation in the activity, including injury or death to self, and damage to property, however such claim may arise, including but not limited to breaches of duty (such as breach of the duty of care) and acts of current or future negligence by Releasees, their respective officers, employees, or agents (nonexclusive examples are negligent care, supervision, or control). This release waives any claims whatsoever against the Releasees arising from the actions of any other participant in the activity or any other third party. Further, this release covers all activities immediately before and after participation, including transportation to or from the event, and waiting for rides from City or School facilities after the event.
3. The undersigned further agrees to defend and hold harmless releases, their respective officers, employees, or agents against any claim, cause, loss, cost, or damage whatsoever, including attorney fees, that arises from the above-described activity. This release is specifically intended to indemnify the Releasees from any act of negligence of the undersigned.
4. Participation involves a risk of injury. By signing this form, you represent that you have considered the risks of participation in the activity, have obtained any medical clearance necessary to participate, and are able to participate without harm to yourself or others. You represent you will use any program equipment with care for yourself, other participants, and your surroundings.
5. In the event of injury, program supervisors shall administer basic first aid, and shall summon emergency services via 911. Supervisors are not trained to provide detailed medical care, and shall not, without prior agreement, provide medications. All costs of emergency care are the responsibility of the participant/ participant’s legal guardian(s). NO INSURANCE IS PROVIDED BY THE CITY FOR INJURY TO PARTICIPANTS. All claims for reimbursement of medical care costs, including emergency transportation, are hereby waived.
6. Parents or others may take audio or video recordings of the participants. The City does not supervise or restrict recordings of public activities by third parties. You agree that photos or videos may be used in promotional materials produced by the City to encourage participation in the activity.
7. You agree to follow all rules of conduct established in conjunction with the activity. Failure to follow the rules will result in your removal from the activity, and you agree that any program fees paid will be kept and not refunded. In the event of a problem while engaged in the activity, notify the activity manager/supervisor.
8. This Release and Hold Harmless is given in partial consideration of your being allowed to participate in the activity described, and binds yourself, your personal representatives, and any heirs or assigns.
9. I have completed all information requests fully. Any answer found to be willfully untrue shall subject the applicant to forfeiture of the request, loss of online registration privilege, and further sanction as allowed by Park Board Policy or Law.

I HAVE READ THIS DOCUMENT CAREFULLY, AND UNDERSTAND IT. I AM SIGNING THIS FREELY AND WITHOUT RESERVATION OR CONDITION. (IF YOU HAVE ANY QUESTIONS ABOUT THIS DOCUMENT DO NOT SIGN IT. CONTACT AN ATTORNEY TO ASSIST YOU.)

Dated this _____ day of _______________, 20_____.

If you are signing on behalf of a minor, BOTH PARENTS MUST SIGN. In the case of a single parent home, the custodial parent must sign. If you are registering your child for class electronically, completion of the registration will be considered your consent and agreement with this document.


(signature) (print name)
Program Participant (must sign only if 18 or older)

(signature) (print name)
Parent (must sign if participant is less than 18 years old)

(signature) (print name)
Parent (must sign if participant is less than 18 years old)

on facebook at MFMvolleyball

Clinton Camp Information 2011

2011
Clinton MM
34th Annual
Volleyball
Camps
June 20-24, 2011
Camp Director: CHS Head Coach
Mark Massey

Grade9-12 (fall ’11) 8-110:30AM__________
Grade 7 &8 (fall ’11)10:30-12:30pm________
Grade 5 & 6 (fall ’11)1:00-2:30pm___________
Grade 9-12 x session: 2:30-4:30pm _____

**all grade levels are the grade levels in the fall of 2011
Location: Jefferson Elementary School. Enter at the North Door.

Staff: Clinton High Varsity Coach, Mark Massey, will direct each camp. Other members of the staff will assist him. In addition, high school & college players will be used as instructors & demonstrators.
Emphasis: The camps for younger players will emphasize the basic fundamentals of volleyball. While working on basics the goal is to make volleyball fun for the young camper. At the middle school level we will continue to work on basic skills, while introducing team concepts. Varsity camp will emphasize fundamentals, as well as advanced team concepts and situations. These camps are geared to the team concepts & philosophies taught in the Clinton Volleyball program.
T-Shirt: Each camper will receive a camp T-shirt.
Cost: $65 total if registered by June 13, 2011 with a full payment, $75 if registered after June 13. Family price: full tuition 1st camper, $45 for the 2nd. (please register together) No child will be refused admission, please call if we can be of help. There are camp scholarships available. Refund requests after June 1 will incur a $15 service charge. *5th & 6th grade Cost = $50 by June 13, $55 after June 13.
**** High School players may come in the AM or PM or Both.
• This is the longest running & largest VB camp in Eastern Iowa. Sign Up Early – Bring a Friend!!
• Goal of the camp is to have fun & increase confidence while learning skills of teamwork & volleyball. Let’s make you better!


• ____________________
*******************************
VB CAMP 2011
MAIL TO:
MARK MASSEY
1513 12TH AVE N
CLINTON, IA 52732
PH 357-7913
email: mfmass@yahoo.com
Pay to: ‘Mark Massey Volleyball’
Time Registering for:


NAME:______________________________
PARENT’S NAME: _____________________
ADDRESS:____________________________
PHONE:______________________________
EMAIL ADDRESS: _____________________
BIRTHDATE:__________________________
HEIGHT:_____________________________
GRADE & SCHOOL IN FALL OF 2011:_________________
T-Shirt Size_______________
Adult: S, M, L, XL
Children: L

I understand that volleyball can be a physically stressful and dangerous activity. Even with proper supervision, injury can occur. I certify that my child is in good physical condition. I also agree to hold harmless and waive any liability of the Clinton Community Schools, Mark Massey, or any other employees of the Clinton Volleyball Camp.
SAVE THE LEFT HAND SIDE OF THE SHEET! IT IS THE PARENT'S & STUDENT'S RESPONSIBILITY TO BE AWARE OF TIMES & DATES. REFUNDS WILL ONLY BE GRANTED IN THE EVENT OF INJURY.

_______________________
(parent’s signature)

***Camp numbers are increasing each year. Register early to guarantee a spot and a T-Shirt.
Please keep this side for reference.

The girls union recently announced that there will be 5 classes in volleyball & girls' BB next year. Clinton will be one of 40 schools in 5A.

Notes on Bettendorf League

Bettendorf League:
We have done this league with various levels of teams for the past 15 years. For the past 5-6 years we've had varsity, soph, and frosh teams in the league each summer. We have found it to be a valuable tool as a part of our summer lead in to the fall season. We create a "double schedule" so that we play two back to back matches. This allows more play for everyone. I would like a commitment as soon as possible on this.


Bettendorf Parks & Recreation (Wednesdays)
Varsity Summer Volleyball Schedule 2011



1. Pleasant Valley 13. United Township
2. North Scott 14. DeWitt Gold
3. DeWitt Purple 15. Stars & Spikes 2
4. Bettendorf Gold 16. Clinton Black
5. Maquoketa 17. Rockridge
6. Moline White 18. Davenport West
7. Clinton Red 19. Rock Island Alleman
8. Stars & Spikes 1 20. Davenport North
9. Rock Island 21. Moline Maroon
10. Geneseo 22. Davenport Central Red
11. Davenport Central Blue 23. Bettendorf Black
12. Assumption Black 24. Assumption Red