Player Registration - Northwest Youth Volleyball

Please note that all information we gather in this form is held private on our system. This information will be destroyed at the conclusion of the volleyball season. Please note that by participating in this league, your image may appear in court scenes posted on the website. At no time will names be published with the photo.

Team*

Email*

Player First Name*

Player Last Name*

Your School*

Grade Level*

Address*

Address Line 1

Address Line 2

City*

State or Region*

Country*

Zip*

Birth Date*

Jersey Number

Code of Conduct *

I will not berate the officials or “trash talk” to my opponent.
I will not use profanity.
I will encourage good sportsmanship by demonstrating positive support for all players, coaches, contest administrators and officials at every game.
I will place the emotional and physical wellbeing of my teammates and opponents ahead of my personal desire to win.
I will treat other players, coaches, fans and officials with respect regardless of race, gender, creed or ability.
I will do my best to remember that youth sports is supposed to be FUN and that winning and losing are part of everyone’s experience.
I will express my concerns through the proper channels in a dignified manner.
I will respect the volunteers that are assisting with the conduct of these events.
I will not “show-boat” or play outside the bounds of the proper etiquette of the game.

I accept

Concussion Waiver *

A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head, or by a blow to another part of the body with the force transmitted to the head. They can range from mild to severe and can disrupt the way the brain normally works. Even though most concussions are mild, all concussions are potentially serious and may result in complications including prolonged brain damage and death if not recognized and managed properly. In other words, even a “ding” or a bump on the head can be serious. You can’t see a concussion and most sports concussions occur without loss of consciousness. Signs and symptoms of concussion may show up right after the injury or can take hours or days to fully appear. If your child reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, seek medical attention right away.
Symptoms may include one or more of the following: 
•  Headaches 
•  “Pressure in head” 
•  Nausea or vomiting 
•  Neck pain
•  Balance problems or dizziness 
•  Blurred, double, or fuzzy vision 
•  Sensitivity to light or noise 
•  Feeling sluggish or slowed down
•  Feeling foggy or groggy 
•  Drowsiness 
•  Change in sleep patterns 
•  Amnesia 
•  “Don’t feel right” 
•  Fatigue or low energy 
•  Sadness 
•  Nervousness or anxiety 
•  Irritability 
•  More emotional 
•  Confusion 
•  Concentration or memory problems
•  forgetting game plays
•  Repeating the same question/comment 
Signs observed by teammates, parents and coaches include: 
•  Appears dazed 
•  Vacant facial expression 
•  Confused about assignment 
•  Forgets plays 
•  Is unsure of game, score, or opponent 
•  Moves clumsily or displays incoordination 
•  Answers questions slowly 
•  Slurred speech 
•  Shows behavior or personality changes 
•  Can’t recall events prior to hit 
•  Can’t recall events after hit 
•  Seizures or convulsions 
•  Any change in typical behavior or personality 
•  Loses consciousness 
What can happen if my child keeps on playing with a concussion or returns too soon?
Athletes with the signs and symptoms of concussion should be removed from play immediately. Continuing to play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to greater injury. There is an increased risk of significant damage from a concussion for a period of time after that concussion occurs, particularly if the athlete suffers another concussion before completely recovering from the first one. This can lead to prolonged recovery, or even to severe brain swelling (second impact syndrome) with devastating and even fatal consequences. It is well known that adolescent or teenage athlete will often under report symptoms of injuries. And concussions are no different. As a result, education of administrators, coaches, parents and students is the key for student-athlete’s safety.
Any athlete even suspected of suffering a concussion should be removed from the game or practice immediately. No athlete may return to activity after an apparent head injury or concussion, regardless of how mild it seems or how quickly symptoms clear, without medical clearance. Close observation of the athlete should continue for several hours. The new “Zackery Lystedt Law” in Washington now requires the consistent and uniform implementation of long and well-established return to play concussion guidelines that have been recommended for several years:
“a youth athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time” and 
“…may not return to play until the athlete is evaluated by a licensed heath care provider trained in the evaluation and management of concussion and received written clearance to return to play from that health care provider”. 
You should also inform your child’s coach if you think that your child may have a concussion. Remember, it’s better to miss one game than miss the whole season. And when in doubt, the athlete sits out. 
For current and up-to-date information on concussions you can go to: http://www.cdc.gov/ConcussionInYouthSports/
Because of the dangers of volleyball, I recognize the importance of following the coaches' instructions regarding techniques, training and other team rules, etc., and to agree to obey such instructions.
In consideration of Cornerstone Christian School permitting me to play in the Northwest Youth Volleyball League - I have read the above warnings and I understand their terms.

I accept

Warning *

I am aware that volleyball is a high-risk sport and that practicing  or competing  in volleyball will be a dangerous activity involving MANY RISKS OF  INJURY. I understand the dangers and risks of practicing and competing in volleyball include but are not limited to, death, serious neck and spinal injuries which may result in complete or partial paralysis,  brain damage,  serious injury  to virtually all internal organs, serious injury to virtually all bones, joints, ligaments, muscles, tendons and other aspects of the muscular skeletal system, and serious injury or impairment to other aspects of my body,  general health and well being. I understand that the dangers and risks of practicing or competing in volleyball may result not only in serious injury, but in a serious impairment of my future abilities to earn a living, to engage in other business, social and recreational activities and generally to enjoy life.  I also understand  that the sport in which I participate may be so inherently dangerous that no amount  of reasonable  supervision, protective  equipment or training can eliminate all vestiges of danger. I am informed the School does not assume the responsibility  for the medical  services required  for these risks.
Because of the dangers of volleyball, I recognize the importance of following the coaches' instructions regarding techniques, training and other team rules, etc., and to agree to obey such instructions.
In consideration of Cornerstone Christian School permitting me to play in the Northwest Youth Volleyball League - I have read the above warnings and I understand their terms.

I accept

Photos *

League participants and organizers will wish to take wide-angle, more general images of the event, the site, opening and closing ceremonies, etc. It’s usually not reasonable, practical or proportionate to secure consent for every participating child in order to take such images, or to preclude such photography on the basis of the concerns of a small number of parents. With acceptance of this warning, we make clear to all participants and parents that these kinds of images will be taken, and for what purposes.
By applying for a spot to play in the Northwest Youth Basketball League I give consent for the use of photos of myself to be used publicly. I also understand and agree that my name will not be placed in the photo as a means of identifying me.

I accept

Legal Guardian*

Emergency (Parent) Contact*

Emergency Phone Number*

Parent Email*

Medical Alert*

NoYes

If yes above, please specify

Insurance Provider*

Insurance Group Number*

Player Signature*