2. 
3. Volleyball Registration

   Fall 2023

5. 1. Fill out the following information, and select the clinic/clinics in which you’d like to attend below. Then fill out the waiver and photo release.
   2. If completing the forms digitally, email finished documents to lvandersnick@springfieldmo.gov. You can also mail completed documents to: Davis House, C/O Lori Vandersnick, 5780 S. Farm Rd. 141, Springfield, MO 65810
   3. Payment is due to confirm your registration. An invoice will be emailed to you upon receipt of registration, or you can call Lori at 417-838-1275 with credit card information.  Please make all checks payable to CSDP.

   All clinics are held at Fieldhouse Sportscenter, 2235 W. Kingsley St., Springfield, MO. Sessions are $15-20/class. Sign up for as many as you like. 

7. Player Name
8. Grade (2023-2024)
10. Address
12. City
13. State
14. Zip Code
16. Phone Number
17. Email Address
19. Parent/Legal Guardian Name
21. Clinics

    Clinics occur on Thursdays, Nov. 2 and 9. Sign up for one or both. Fee is per clinic.

23. VolleyTikes - $15

    Ages 4-6 yrs.
    Thurs., 4-4:45 p.m.

24. 1. Nov. 2

    1. Nov. 9
26. VolleyKids - $15

    Ages 7-9 yrs.
    Thurs., 4-4:45 p.m.

27. 1. Nov. 2

    1. Nov. 9
29. 3rd-4th Grade - $20

    Thurs., 5-6:15 p.m.

30. 1. Nov. 2

    1. Nov. 9
32. 5th-6th Grade - $20

    Thurs., 6:15-7:30 p.m.

33. 1. Nov. 2

    1. Nov. 9
35. 7th-8th Grade - $20

    Thurs., 7:30-8:45 p.m.

36. 1. Nov. 9
40. Waiver and Release

    In consideration of being allowed to participate in any way in the Greater Springfield CSDP sports programs the managed competitions, tournaments, clinics, related events and activities, I, the undersigned acknowledge, appreciate, and agree that:

    1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
    2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown. EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
    3. I willingly agree to comply with the stated and customary terms and conditions for participation.  If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
    4. I for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS
    5. The Greater Springfield Community Sports Development Program and their Board of Directors, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releases”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

    I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

42. Signed and Delivered This
43. Day of
    -- Select One --12345678910111213141516171819202122232425262728293031
44. Month
    -- Select One --JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
46. Participant Signature*
47. Participant Age*
49. For Participants of Minor Age

    This is to certify that I, as parent / guardian with legal responsibility for this participant, do consent and agree to his / her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin. I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above.  EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

51. Parent/Legal Guardian Signature*
52. Emergency Phone Number*
54. Photo Release*
    -- Select One --YesNo

    I give my permission for the aforementioned participant to be photographed while participating in CSDP activities, and to use any photographs for promotional purposes.

Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field