Boys Club Registration 2018 August 16, 2018 by Coach Arlen Click here to download a flyer. Keiki Opio Volleyball Academy (KOVA)Open to Boys 12-16 Forming 14U & 16U teams Use this chart to determine your child's age group. Tryout Date: Wed. September 5th at Hanalani Schools 6:30-8:30PM Registration Form $10 Tryout Fee per player. If registering multiple players, please fill out the form multiple times. Player Info:Are you registering a second (or more) player?If you have filled out the entire form for your first child, you can skip some information.No, I am filling this form out for the first time.Yes, I have filled out the entire form for one player and I'm registering multiple players.Player's Name* Player's School:What school does this player attend?Player's Gender:*MaleFemalePlayer's Age:*Please enter a number from 1 to 20.Player's Birthdate:* Player's T-Shirt Size:*Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLLiability & Media Waiver:KEIKI OPIO VOLLEYBALL ACADEMY (KOVA) LIABILITY AND MEDIA WAIVER: By digitally signing, I agree to fully discharge and do forever release, acquit, discharge Keiki Opio Volleyball Academy (KOVA) or practice facility owners, and it's officers, agents, servants, employees, and organizers from injuries, including death, damage, or loss which my child may accrue on account of participation. I herby authorize the personnel of Keiki Opio Volleyball Academy to take any necessary steps for the required medical treatment for said child/ward. I hereby forever release, Keiki Opio Volleyball Academy from any and all liability for any medical or dental treatment decision made for the treatment of the child/ward. I also give Keiki Opio Volleyball Academy to take photos and video of my child for promotional, educational, news, and public purpose only in print and/or electronic media. It is my responsibility to notify the Keiki Opio Volleyball Academy in writing if I do not wish to have my child photographed or videotaped.Emergency Contact:*Emergency Contact Cell Phone:*Secondary Emergency Contact:Secondary Emergency Contact Cell Phone:Insurance Company & Policy Number:Dental Company & Policy Number:Medical Conditions and Allergies:Please list all medical conditions and allergies. Digital Signature:*Please fill in your full name as your digital signature.Parent (Guardian) Information:Please give us some contact information in case we need to get a hold of you. Father/Guardian: First Last Father/Guardian Email: Father/Guardian Cell Phone:Mother/Guardian: First Last Mother/Guardian Email: Mother/Guardian Cell Phone:Payment Information:Credit Card Holder's Name:* First Last Email* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name $10 Tryout Fee: Price: $10.00 PhoneThis field is for validation purposes and should be left unchanged. Share this:FacebookTwitterGoogle
