2015 Disclosures and Financial Agreement

2015 Disclosures and Financial Agreement
1.
Insurance Disclosure
I understand that the insurance provided by the Northern California Volleyball Association (NCVA) covers my daughter only as a
participant during volleyball practice and during tournament play at tournament site gyms for the 2015 season. The NCVA insurance
does not cover accidents that might occur to and from the practice and tournament sites.
2.
Fees Disclosures
♦ NCVA Membership = $60.00 – All Players are required to register with the NCVA prior to Registration Night on Tuesday,
November 11, 2014
♦
Club Kalani Total Fees:
Power League = $2,500
• Registration = $500.00 –Non-Refundable and Due on
Registration Night on 11/11/2014
• Membership = $2,000.00
• Tournament Registration
Power League Tournaments
Special Tournaments - Choice of 3
Non League Tournaments: Choice of 3
Officials Clinic
•
•
•
Premier League = $1,900
Registration = $500.00 –Non-Refundable and Due
on Registration Night on 11/11/2014
Membership = $1400.00
Tournament Registration
Premier League Tournaments
Special Tournaments - Choice of 2. Note:
Additional fees will apply towards the No
Dinx/NCVA Far Western National Qualifier
Non League Tournaments: Choice of 2
Officials Clinic
•
Membership Inclusions:
a.
Provide instructions on the fundamentals of competitive volleyball and gain tournament experience.
b.
Conditioning
c.
Membership Fees
e.
Coaches Salaries and Practice Gym Rentals
f.
Full Uniform
•
Non-Inclusions:
a.
Food for tournaments, transportation and lodging costs
b.
For tournaments requiring overnight stay, all Players (team members) will divide the total cost for the team’s lodging,
transportation and parking costs incurred by the chaperones, and the cost for the Coach’s lodging and parking. These
costs will be divided equally by all Players, regardless of whether or not all Players participate in that tournament.
c.
Other miscellaneous items as agreed upon by the team
3.
Club Kalani Player Loyalty Program
Returning players from the prior year season will receive a discount of $150.00
4.
Full Financial Obligations – Parents and Players
We, the undersigned, agree to participate under the Club Kalani Policies and Guidelines. We will satisfy our financial and volunteer
obligations. We understand that there will be no refund unless there is an incident related to a season ending injury or a family crisis.
If the incident occurs prior to February 15, 2014, then any refund will be pro-rated. There will be no refunds for incidents occurring
after February 15, 2014.
5.
Payment Terms
a.
I agree to pay a non-refundable Registration Fee of $500.00 due at Registration on 11/11/2014
b.
Membership Fee of $2,000.00 for Power League, OR $1,400.00 for Premier League
i. Balance at Registration or per Payment Schedule below
ii. Payment Schedule:
• 1st Payment due by December 15, 2015, and the minimum required is $500.00 for Power League, and $350.00 for
Premier League. All subsequent payments are due by the 15th of every month
• Entire balance due by March 15, 2015
iii. Failure to comply with the Payment Schedule:
• Result in your daughter to be ineligible to attend practices or tournaments, until the balance is brought up to date.
• For payment extensions, contact our Club Administrator prior to February 15, 2015, or your daughter will be
ineligible for the remainder of the season
November 2014
Page #1
2015 Disclosures and Financial Agreement
Any unpaid balance after March 15, 2015 will be referred to our collection agency, I.C. Systems, Inc., and your
daughter will be ineligible for the remainder of the season
iv. Payment Remittance
• By Check: Payable to Club Kalani, and mailed to 2601 C Blanding Avenue, Box 324, Alameda, CA 94501
• By Debit/Credit Cards: Online thru our website at www.clubkalani.com
•
Uniforms:
Uniform Item
Indicate Size (Men’s)
YL (Youth Large), S, M, L, 2XL
Uniform # 1-20
(priority to Returning Players)
Jersey (2)
Spandex Shorts (2)
Returning Player
1st
2nd
Yes
No
Warm-Ups (1)
Backpack
Payment Information:
Registration
Power League
Premier League
$500.00
$2,000.00
$1,400.00
Pay By:
Cash
Returning Player
Discount
$150.00
Total 2015 Fees
Check (Indicate check #)
Amount Received
Credit Card (Online)
I understand the disclosure statements and agree to the payment terms. I also understand that if I default on my financial obligation, then
my daughter will be ineligible to attend practices or tournaments until payment is made. I request my daughter to play for Club Kalani
Volleyball during the 2015 club season. As a player, I am committing for the entire season to attend all practices and tournaments.
Team
Coach
Player Birthdate
Player Name (Print)
Player Signature
Date
Parent 1 Name (Print)
Parent 1 Signature
Date
Parent 2 Name (Print)
Parent 2 Signature
Date
Parent1 Email
Parent2 Email
Player Email
Player School
Address
City
Home #
Player Cell
Parent 1 Cell
Parent 2 Cell
November 2014
HS Grad Year
State/Zip
Page #2
NCVA Letter of Commitment
DO NOT SIGN WITHOUT READING CAREFULLY; DO NOT SIGN BEFORE 6:00 PM ON NOVEMBER 10, 2014 FOR TRYOUTS HELD
BETWEEN NOVEMBER 1st AND NOVEMBER 9th. DO NOT SIGN BEFORE 48 HOURS AFTER TRYOUTS HELD AFTER NOVEMBER 9,
2014.
NOTE: IT IS A VIOLATION OF NCVA POLICY TO POST-DATE THIS DOCUMENT.
This requirement has been created to protect the player and parent/guardian as a member of a club. It is not intended to bind a player to a club.
1.
Basic Penalty. I understand that by signing this letter I am committed to joining the club named within this document for the entire
2014/2015 season. If I compete with another club, I may be subject to suspension for the remainder of the season.
a.
b.
c.
Early Signing Penalty. A player who signs a Letter of Commitment before 6:00 PM on November 10, 2014 for tryouts held
between November 1st to November 9th, and 48 hours after tryouts that are held after November 9th is subject to suspension for the
entire season. A club representative may not ask a player to sign before 6:00 PM on November 10, 2014 for tryouts held
between November 1st to 9th and before 48 hours after tryouts held after November 9th.
A player may not sign a Letter of Commitment, before 6:00 PM on Monday, November 10, 2014 regardless of the date of the
tryout, for tryouts held between November 1st to November 9th and before 48 hours after tryouts held after November 9th. A player
who signs a Letter of Commitment or a club that allows a player to sign at a tryout before these dates is subject to suspension for the
entire season. Under no conditions may the Letter of Commitment be pre-signed or pre-dated before this time frame has expired.
In turn, no deposit monies, team or club fees can before taken be 6:00 PM on Monday, November 10, 2014, for tryouts held
between November 1st to November 9th, and no deposit monies, team or club fees can be taken until after 48 hours for tryouts after
November 9th.
Only One Letter of Commitment Permitted. A player who signs more than one Letter of Commitment with more than one club
is subject to suspension for the entire 2014-2015 season.
2.
Verbal Commitments. A player may commit verbally to a club before November 10, 2014. A verbal commitment is not
binding. The player may revoke the commitment at any time, before signing a Letter of Commitment, without penalty.
3.
Recruiting Ban after Signing. I understand that all clubs are obligated to respect my signing and shall cease to recruit me upon
my signing this document. I shall notify any recruiter who contacts me that I have signed.
4.
Club Signatures Required Prior to Submission. This document must be signed and dated by the Club Director before
submission to me and my parents (or legal guardian) for our signatures.
5.
Parent/Guardian Signature Required. My parent or legal guardian is required to sign this Letter of Commitment if I am less
than 21 years of age at the time of signing.
6.
Falsification of Letter of Commitment. If I falsify any part of this Letter of Commitment, including the date, I understand that I
am subject to suspension for the entire 2014-2015 season.
7.
Nullification of Other Agreements. My signature on this Letter of Commitment nullifies any agreements, verbal or otherwise,
which would release me from the conditions stated within this document.
8.
Binding Agreement. I understand that I have signed this Letter of Commitment with the club and not with a particular
individual. If the coach or any player(s) leaves the team, I remain bound by the provisions of this document. If a club makes
dramatic material changes from what was promised, then it may be grounds for a release from the commitment. Examples
include, but are not limited, to significant changes in practice schedule, practice location, tournament schedule, cost, etc.
I certify that I have read all terms and conditions in this document. I have discussed them with the club representative named
within, and I fully understand, accept, and agree to be bound by them.
Club Kalani
Club Name: ________________________________
Team Name: ____________________________
Player’s Name: ______________________________
Signature: ______________________________
Date: _________
Address: ___________________________________
City: ________________________ State: _____
Zip: __________
Parent’s Name: ______________________________
Signature: _______________________________
Date: _________
Parent Phone #: ______________________________
Parent Email: ____________________________
Date: _________
Roy Ching
Club Directors: ______________________________
Signature: _______________________________
THIS FORM IS TO BE CARRIED TO ALL SANCTIONED COMPETITIONS & PRACTICES.
2014-2015 USAV YOUTH & JUNIOR VOLLEYBALL PLAYER
MEDICAL RELEASE FORM
This must be completed - legibly - and signed in all areas by both the player and his/her parent or guardian. I understand and agree that this
document will be kept in the possession of authorized adult team personnel and that reasonable care will be used to keep this information
confidential. By signing this form the participant affirms having read and agreed to the terms and conditions listed below.
Club Kalani
Club:
Team Name:
 Male
First Name
Last Name
Primary Contact: Parent or Guardian
Name:
 Female
Age
Address:
City, State & Zip
Alternate Phone:
Primary Phone:
Secondary Contact:  Parent/Guardian
Name:
Primary Phone:
Birth Date
Other
Alternate Phone:
Primary Insurance Co
Primary Group/Policy #
Family Physician Name
Physician Phone
/
Please elaborate on any medical conditions of which we should be aware:
Please list any medications currently being taken:
In the past 24 months, have you been tested, diagnosed and/or treated for a concussion:  Yes  No
If yes, provide the date (months and year), who performed the testing/diagnosing/treatment and what was the outcome:
Please list any allergies:
If None, please write None.
Participant Signature
Date:
(regardless of age):
Participant,
, has my permission to participate in training,
competition, events, activities and travel sponsored by USA Volleyball or any of its Regional Volleyball Associations (RVAs). I approve
of the leaders who will be in charge of this program. I recognize that the leaders are serving to the best of their ability. I certify that the
participant has full medical insurance with the company listed above. I understand and agree that this document will be kept in the
possession of authorized adult team personnel and that reasonable care will be used to keep this information confidential. I agree to
allow the authorized adult team personnel to release this information in the event of a medical emergency to a third party medical
provider. I also certify to the best of my knowledge that the participant named hereon is physically fit to engage in the activities
described above.
Parent/Guardian Signature:
Relationship to Participant:
Date:
If, during the course of my daughter's/son's activities in volleyball, she/he should become ill or sustain an injury, I hereby authorize you
to obtain emergency medical/dental care. I will assume financial responsibility for the bills incurred through my insurance company.
Signature:
Date:
Parent/Guardian
or
I do not authorize emergency medical/dental care for my daughter/son.
Signature:
Date:
Parent/Guardian
Revised 06/24/2014