Summer Clinics Summer Clinics 2019June Clinics-All Skills Clinics for Girls and Boys Ages 7-17 $40 Mahiko Outside 6:30-8:30pm Monday’s (2 days) June 10,17 Walk in fee that day $25 —————————————— July Clinics-All Skills Clinic forGirls and Boys Ages 7-17 $130 Walk in that day fee $25 Thursday’s July 11,18,25 Hanalani outside 6:30-8:30pm Tuesday’s July 16,23,30 Mahiko gym 6:30-8:30pm —————————————— KOVA Fitness on the Beach Monday July 8 and 22 @ 5:30-7pm $15 Pu’uloa Beach Park which is Across from Ewa Beach Golf Course Boys and Girls Ages 8-18 (Adults are able to sign up too) We will be taking 35 Max ParticipantsJune Clinics- $40June Clinics-All Skills Clinics for Girls and Boys Ages 7-17 $40 Mahiko Outside 6:30-8:30pm Monday’s (2 days) June 10,17 Walk in fee that day $25 Price: $40.00 Quantity: July Clinics- $130July Clinics-All Skills Clinic forGirls and Boys Ages 7-17 $130 Walk in that day fee $25 Thursday’s July 11,18,25 Hanalani outside 6:30-8:30pm Tuesday’s July 16,23,30 Mahiko gym 6:30-8:30pm Price: $130.00 Quantity: Fitness on the Beach- $15KOVA Fitness on the Beach Monday July 8 and 22 @ 5:30-7pm $15 Pu’uloa Beach Park which is Across from Ewa Beach Golf Course Boys and Girls Ages 8-18 (Adults are able to sign up too) We will be taking 35 Max Participants Price: $15.00 Quantity: 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:* Date Format: MM slash DD slash YYYY 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 Info:Please see Alicia when you check in for the clinic to pay via Cash, Check, or Square App. Email*For clinic confirmation and club communications. Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Total $0.00 PhoneThis field is for validation purposes and should be left unchanged.