Registration 2023.2 | Lil Spikers Volleyba

SESSION 2

WHEN: September 24, October 1, 8, 15, &22
TIMES:

8:30 am – 10:00 am: Ages 5-8

10:15 am – 11:45 am: Ages 9-11

WHERE: PEARL CITY HIGH SCHOOL GYM
2100 HOOKIEKIE STREET
PEARL CITY, HI 96782
USE WAIMANO HOME ROAD ENTRANCE

CONTACT:

Stephanie Shigemasa

E-mail: lilspikersvba@gmail.com

(808) 561-2239

WAIVER & REGISTRATION

Athlete's First Name

Athlete's Last Name

Parent/Guardian Name

Phone

Street Address

City

State

Postal / Zip code

Date of Birth

Please specify any medical condition we should know about. If there are no conditions please indicate "None"

By checking the box, I, the parent and/or guardian of the above named applicant, hereby give my approval to said applicant’s participation in the Lil’ Spikers Volleyball Academy. I assume all risks and hazards incidental to all participation and do forever RELEASE, acquit, discharge, and covenant hold harmless Stephanie Shigemasa, any volunteers, and their representatives, from any and all liability from any and all actions, causes of actions, and claims for any injury or damage, and any and all liability for any such injury or damage. I hereby authorize the personnel of Lil’ Spikers Volleyball Academy to take any necessary steps for the required medical treatment for said child/ward. I hereby release Lil’ Spikers Volleyball Academy from any and all liability for any medical treatment decisions made for the treatment of said child/ward.

By checking the box, I give permission for the Lil’ Spikers Volleyball Academy and any of its affiliated organizations to use the name of my child and/or his/her photograph for promotional, news, or public relations purposes in print and/or electronic media. I understand that it is my responsibility to notify the academy in writing if I do not wish to have my child photographed or videotaped.

I declare that the info I’ve provided is accurate & complete

*If you do NOT agree to the above Liability and Media Release statement please understand that your child may not participate.

Select an item ($)

Ages 5 - 8 - $120

Ages 9-11 - $120

*Sorry, we do not issue Refunds. We will issue Credit towards a FUTURE Session. Credit must be used before registration closes.*

Thanks for registering!

SESSION 2

WHEN: September 24, October 1, 8, 15, &22 TIMES:

WHERE: PEARL CITY HIGH SCHOOL GYM 2100 HOOKIEKIE STREET PEARL CITY, HI 96782 *USE WAIMANO HOME ROAD ENTRANCE*

CONTACT:

WAIVER & REGISTRATION

WHEN: September 24, October 1, 8, 15, &22
TIMES:

WHERE: PEARL CITY HIGH SCHOOL GYM
2100 HOOKIEKIE STREET
PEARL CITY, HI 96782
USE WAIMANO HOME ROAD ENTRANCE