2018 Fall Volleyball – 5th and 6th Grade

Membership

Membership is a one time annual fee that is required to participate in any Girls Place program. Membership fees are $20 for one child and $40 for families with two or more girls participating and are valid from January 1st - December 31st. Membership is nonrefundable and nontransferable. New members will be assessed the appropriate membership fees when they register for the fall volleyball program. Please call (352) 373-4475 if you would like to verify that your membership has been paid for 2018.

2018 Girls Place Membership*

An active 2018 Girls Place Membership is required to participate in all Girls Place programs. If you are unsure of your membership status, please call 352-373-4475.

Fall Volleyball Participation Fee

The participation fee for the season is $110. An active 2018 Girls Place membership is required to participate.

Player Information

This registration form is ONLY for girls going into the 5th and 6th grade during the 2018-2019 school year. If your daughter is NOT in the 5th or 6th grade, please press the "back" button on your browser and select the correct registration form. No spots will be saved for those who filled out the wrong form. Your name will go to the bottom of the waiting list. NO EXCEPTIONS!

Name*

First Last

Date of Birth*

mm/dd/yyyy

Age*

Height (Feet, Inches)*

Race*

Please list any medical conditions we should be aware of (asthma, allergies, previous injuries, etc.)*

Jersey Size*

Grade Level in AUGUST 2018*

School Attending in AUGUST 2018/19*

Other school (not listed above)

Please identify.

Address*

Street Address Address Line 2 City State ZIP Code

Main Phone Number*

Volleyball Information

The information is used in conjunction with evaluations to make teams as even and fair as possible. Please help us by selecting the options that best fit your daughter's playing experience and skill.

Volleyball Skill*

Please select the option that most closely relates to your daughter's volleyball skill level for her age group. 1 = Beginner. Little to no experience, does not know proper form and has little to no understanding of the game. 5 = Advanced. well-rounded player, uses proper technique and has a solid understanding of all aspects of the game.

Volleyball Experience*

Select the number of seasons your daughter has participated on a volleyball team in an organized league.

Volleyball Practice

In order to make teams as fair as possible, we cannot accept requests for specific coaches or practice times. We will do our best to accommodate requests, however we cannot guarantee that you will receive your preferred practice days.

Preferred Practice Days*

Practices take place twice a week for one hour and are held between 4:30pm and 9:30pm. Practice times are assigned when teams are announced at the beginning of the season and will stay the same for the entire season.

Pre-Season Evaluations

Your daughter MUST attend an evaluation day. Evaluations are necessary for us to make teams as fair as possible. Your daughter will go through various drills with coaches so that we can determine her skill level.

Select Your Evaluation Day*

If you need to adjust your evaluation date in the future pleace contact Ms. Kaihla via email at Kaihla@girlsplace.net

Parent/Guardian Information

Guardian #1 Name*

First Last

Relationship to Child*

Email Address: MUST be checked regularly*

PLEASE DOUBLE CHECK YOUR EMAIL - THIS WILL BE THE MAIN LINE OF COMMUNICATION THROUGHOUT THE SEASON.

Place of Employment

Job Title

Office Phone

Cell Phone*

Guardian #2 Name

First Last

Relationship to Child

Email Address: MUST be checked regularly

PLEASE DOUBLE CHECK YOUR EMAIL - THIS WILL BE THE MAIN LINE OF COMMUNICATION THROUGHOUT THE SEASON.

Place of Employment

Job Title

Office Phone

Cell Phone

Emergency Contact

Emergency Contact's Name*

First Last

Must be someone other than a parent or guardian.

Relationship to Child*

Cell Phone Number*

Work Phone Number

Volunteer with Girls Place Athletics!

Please select any and all positions you are interested in helping with this season.

Volunteer Head Coach
Volunteer Assistant Coach
Volunteer Concessions
Volunteer Fundraising
Volunteer Referee
Volunteer Team Sponsor

Demographics

The following is optional and ONLY used to assist us in obtaining funding and various grants. THIS INFORMATION WILL BE HELD CONFIDENTIAL.

Child resides with (check all that apply):

Mother
Father
Stepfather
Stepmother
Grandparent
Aunt/Uncle
Foster Parent
Other

If other, please identify:

Who is the head of household?

Mother
Father
Stepfather
Stepmother
Grandparent
Aunt/Uncle
Foster Parent
Other

If other, please identify:

Annual Family Income*

Please remember that this information is held confidential and is used for reporting purposes and securing grants to better serve you.

Total # of adults (18 and older) in household

Total # of children (0-17 years old) in household

How did you hear about Girls Place?

If other, please identify:

Family Spirit Shirts

Want to order a shirt in your child's team color with her name on the back? Please place your order now to have your shirts by the first game of the season! Shirts must be paid for by the registration deadline, AUGUST 17TH. Non-payment will result in cancellation of the order.

Type your daughters name EXACTLY how you want it to appear on the back of your spirit shirts.

If left blank, we will use the athlete's first name as listed above. YOU MAY CHOOSE A FIRST OR LAST NAME BUT NOT BOTH.

Youth Small

Price: $10.00 Quantity:

Youth Medium

Price: $10.00 Quantity:

Youth Large

Price: $10.00 Quantity:

Adult Small

Price: $10.00 Quantity:

Adult Medium

Price: $10.00 Quantity:

Adult Large

Price: $10.00 Quantity:

Adult X-Large

Price: $10.00 Quantity:

Adult XX-Large

Price: $12.00 Quantity:

Girls Place Policies and Practices

The following section includes information regarding payments, releases and our programming. Please read this information carefully. You will be held responsible for all of the content. Please contact Kaihla at Kaihla@girlsplace.net with any questions.

PAYMENT POLICY: Payment for Fall Volleyball is due in FULL no later than 6pm on August 17th. Failure to pay by the deadline will result in your daughter being moved to the bottom of the wait list. NO EXCEPTIONS.*

Initial Here

NON‐SUFFICIENT FUNDS (NSF) POLICY : All NSF checks will be charged a $25 NSF fee. Please pay for all NSF checks with cash or money order, as they will not be re-deposited. After two returned checks within one year, cash payments will be required thereafter for services plus any bank services accrued by Girls Place, Inc.*

Initial Here

REFUND POLICY: I understand that once my child is placed on a team, I will not be eligible to receive a refund. The Executive Director shall make the final decision regarding refunds in the event any extenuating circumstances arise.*

Initial Here

TEAM ROSTERS: In order to facilitate communication a team roster will be distributed to your daughter's coaches and teammates at the beginning of the season. Only names, email addresses, and phone numbers will be included on the team roster.*

Initial Here

PHOTO RELEASE: I understand that during activities and events at Girls Place my child may be photographed or videotaped by Girls Place staff. I agree that my child or her likeness can be used in Girls Place publications including newsletters, fliers, and brochures in addition to local newspaper and television promotions.

Initial Here

SOCIAL MEDIA RELEASE: I understand that during activities and events at Girls Place my child may be photographed or videotaped by Girls Place staff. I agree that my child or her likeness can be used in Girls Place's social media outlets like Facebook, Instagram and Twitter.

Initial Here

CODE OF CONDUCT: I acknowledge that I have reviewed and plan to implement the following Sport Parent Code of Conduct for the important message it holds about the PROPER role of parents in SUPPORTING their child in sports. By initialling below you agree that you (and your guests) will abide by the Code of Conduct. Follow the link to view the Code of Conduct http://www.girlsplace.net/?p=3815*

Initial Here

Questionnaire: (Please complete in an effort to provide the most positive experience for your children)

What do you expect your child to gain from the Athletic program at Girls Place?

Below, please give us any input that you would like to share about Girls Place or the athletic program.

For returning families, please share how Girls Place has benefited you and your family. What would your child's life be like without Girls Place?

Signature

I have read and fully understand the contents of this application. I have completed the application to the best of my knowledge and ability. I understand that if any information listed in this application changes, I will notify GIRLS PLACE immediately. The child/children listed above has/have my permission to participate in the activities sponsored by GIRLS PLACE as noted on the program schedules. In the case of an emergency an alternate person will be called if the parent(s) can not be reached by phone. The undersigned, individually and as parent or guardian of the participant, hereby authorize GIRLS PLACE to carry out any measures deemed necessary should an emergency occur, including at the expense of the undersigned, appropriate medical treatment for the participant, and hereby releases the GIRLS PLACE, its employees and agents, from any liability or claims arising out of the participant's engagement in the above described events.

Please type your full name into the box below to serve as your digital signature for this form:*

Type full name here

Fall Volleyball Participation Fee

Total

$0.00

Includes $110 Participation Fee, Membership Fees (if applicable) and any Spirit Shirts ordered.