Illini Elite VBC

Player Information

Player First Name *

Player Last Name *

Date of Birth *

School *

Grade *

---Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade

Player Cell Phone

Please provide in the following format; XXX-XXX-XXXX

Home Address *

City *

State/Province *

Zip *

Country *

Medical Conditions *

Parent Contact Information

Parent Email Address *

Parent Phone *

Cancellation Policy

Cancellation Policy: If you need to cancel your registration, you can receive a refund minus a $50 administrative fee if the cancellation occurs two weeks prior to the start of the activity. No refunds can be given if the cancellation occurs less than two weeks prior to the start of the activity. Please contact Andy or Joe at (309) 829-3671 if you need to cancel a registration.

Payment Policy

You must pay the activity fee to finish registration. If you have not paid the activity fee, you will not be considered registered.

Illini Elite Volleyball Club (hereafter referred to as the “Club”) has put in place numerous preventative measures and enhanced cleaning protocols to reduce the likelihood of spreading COVID-19 in Club’s gym environment; however, the Club cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending sponsored activities at the Club could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily agree to the participation terms described above and assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the Club and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club Directors, Coaches, Athletes and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the Club or participation in Club programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Club, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Club activity.

Waiver Release and Insurance Information

AS CUSTODIAL PARENT OR COURT-APPOINTED GUARDIAN OF THE CHILD ABOVE, I DO FOR BOTH OF CHILD’S PARENTS, FOR CHILD AND CHILD’S HEIRS AND SUCCESSORS, RELEASE ILLINI ELITE VOLLEYBALL, INC. AND ANY OF ITS AGENTS, EMPLOYEES OR REPRESENTATIVES (ALL OF THE FOREGOING COLLECTIVELY "ILLINI ELITE VBC") FROM ALL CLAIMS ARISING OUT OF OR CONNECTED WITH CHILD’S PARTICIPATION IN ANY ILLINI ELITE VBC PROGRAM. I PROVIDE THIS RELEASE BECAUSE I AM MINDFUL THAT ATHLETICS, PHYSICAL TRAINING AND COMPETITION CAN BE A DANGEROUS UNDERTAKING REGARDLESS OF HOW CAREFUL OR PRUDENT ANY PERSON, FIRM OR FACILITY MIGHT BE. FURTHER, I GIVE PERMISSION TO ILLINI ELITE VBC TO TREAT CHILD OR ARRANGE FOR MEDICAL CARE OR TREATMENT FOR CHILD IN ANY SITUATION DEEMED REASONABLY NECESSARY BY ILLINI ELITE VBC IF CIRCUMSTANCES PERMIT, ILLINI ELITE VBC SHALL ATTEMPT TO COMMUNICATE FIRST VIA TELEPHONE WITH THE EMERGENCY CONTACT.

Insurance Information

In the event neither emergency contact can be reached or if the urgency of the situation requires immediate attention without prior telephone contact, ILLINI ELITE VBC may arrange for medical treatment for the Child at the expense of the parent or guardian signing this form. Health Insurance, PPO information for Child is as follows:

Insurance Company *

Policy Number

Parent/Guardian Type Full Name *

By typing your name in the signature box and clicking submit, you agree that you are electronically signing this agreement in accordance with the Electronic Signatures Act (Public Law No: 106-229), and agree to be bound by all terms and conditions.