Please be patient and work through the following 4 Step Registration Process.
All provided information is held strictly in confidence and is very helpful
helping Dick Powers Volleyball help You! - Y E S !
There are FOUR STEPS to complete your online registration for any/all services provided by Dick Powers Volleyball.
- We are capable of helping athletes and their families from "First Effective Training Steps Through Collegiate Recruiting, and Beyond.
- Any information we receive is held "in-house" and only shared with your permission should collegiate recruiting come into play.
Perpetual Legal Waiver Form
Dick Powers Volleyball, Powers Volleyball & Powers Human Development
PERPETUAL APPROVAL, CONSENT, AND DISCLAIMER AGREEMENT FOR DICK POWERS/POWERS HUMAN DEVELOPMENT/DICK POWERS VOLLEYBALL/POWERS VOLLEYBALL/POWERS VOLLEYBALL CLUB/GUTS VOLLEYBALL CAMPS/POWERS VOLLEYBALL CLINICS/POWERS VOLLEYBALL TRAINING PROGRAMS/ASSOCIATED PERSONNEL/HOST INSTITUTIONS, LAKE JAMES CHRISTIAN ASSEMBLY, STROH CHURCH OF CHRIST, HOST FACILITIES, AND PERSONNEL
THE SIGNATURES AND INFORMATION REQUIRED UPON COMPLETION OF ANALYSIS OF THE FOLLOWING FORM AND CONTENTS WILL PROVIDE DOCUMENTATION OF COMPREHENSION AND COMPLIANCE TO THE LEGAL INTENT AND CONDITIONS SET FORTH WITHIN THIS APPROVAL AND CONSENT FORM.
ALL PARTICIPANTS ASSOCIATED ANYTIME, WHETHER DIRECTLY OR INDIRECTLY, WITH DICK POWERS/POWERS HUMAN DEVELOPMENT/DICK POWERS VOLLEYBALL/POWERS VOLLEYBALL CLUB/GUTS VOLLEYBALL CAMPS/TRAINING PROGRAMS/ASSOCIATED PERSONNEL/HOST INSTITUTIONS, FACILITIES, AND PERSONNEL MUST HAVE SIGNED COPY OF APPROVAL AND CONSENT FORM ON FILE WITH DICK POWERS BEFORE PARTICIPATION IS ALLOWED.
CONDITIONS
THE SCRIBING OF APPROPRIATE SIGNATURE(S) FOLLOWING ANALYSIS OF THE FOLLOWING CONDITIONS INDICATE THAT *I **(WE, THOSE THAT ACCEPT RESPONSIBILITY FOR PARTICIPANT) AGREE TO THE CONDITIONS SET FORTH IN APPROVAL AND CONSENT FORM. SIGNATURES ALSO INDICATE PERMISSION FOR ANY PERSONNEL ASSOCIATED WITH DICK POWERS VOLLEYBALL TO TRANSPORT AND PROVIDE FOR MEDICAL TREATMENT.
1. I (WE) CURRENTLY HAVE NO KNOWN PHYSICAL OR MENTAL CONDITION(S) WHICH WOULD IMPAIR CAPACITY TO FULLY AND WILLINGLY PARTICIPATE IN ANY AND ALL ACTIVITIES ASSOCIATED WITH DICK POWERS.
2. I (WE) COMPREHEND AND WILLINGLY PARTICIPATE IN DICK POWERS VOLLEYBALL CAMPS AND TRAINING PROGRAMS UNDERSTANDING THAT PARTICIPATION IN CAMPS AND TRAINING PROGRAMS CARRIES INHERENT RISK OF SERIOUS INJURY, INCLUDING PARALYSIS AND DEATH. I (WE) ALSO UNDERSTAND THAT CONTROLLING ANY RISK IS MY (OUR) PERSONAL RESPONSIBILITY WHICH I (WE) WILL MONITOR AND MAINTAIN CONSTANTLY WHEN IN ASSOCIATION, DIRECTLY OR INDIRECTLY, WITH DICK POWERS.
3. I (WE) WILL INDICATE IN WRITTEN AND SIGNED DOCUMENT ANY CONCERN(S) AND RELEVANT SAFETY AND HEALTH-RELATED INFORMATION WHICH WILL PROVIDE ADDED INSURANCE OF SAFETY AND WELL-BEING WHILE PARTICIPATING IN TRAINING. FURTHER, IF IN ANY CAMP OR TRAINING PROGRAM, INJURY, SICKNESS, OR SUFFRAGE DOES OCCUR, I (WE) WILL HOLD BLAMELESS DICK POWERS/POWERS HUMAN DEVELOPMENT/DICK POWERS VOLLEYBALL/POWERS VOLLEYBALL CLUB/GUTS VOLLEYBALL CAMPS/TRAINING PROGRAMS/ASSOCIATED PERSONNEL/HOST INSTITUTIONS, FACILITIES, AND PERSONNEL.
4. I (WE) DO CONSENT FOR ANY PROGRAMMING ASSOCIATED WITH DICK L. POWERS AND ASSOCIATED PERSONNEL, MEDICAL REPRESENTATIVES, ATHLETIC TRAINERS, HOSPITALS, OR CLINICS, TO PROVIDE RESPONSIVE CARE WITH REGARD TO ANY INJURY AND SICKNESS WHICH COULD OCCUR THROUGH PARTICIPATION IN CAMPS AND TRAINING PROGRAMS.
5. I (WE) COMPREHEND THAT DICK POWERS/POWERS HUMAN DEVELOPMENT/DICK POWERS VOLLEYBALL/POWERS VOLLEYBALL CLUB/GUTS VOLLEYBALL CAMPS/TRAINING PROGRAMS/ASSOCIATED PERSONNEL/HOST INSTITUTIONS, FACILITIES, AND PERSONNEL ARE NOT LIABLE OR RESPONSIBLE FOR PAYMENT OF ANY EXTERNAL EXPENSES INCURRED DUE TO PARTICIPATION IN TRAINING.
6. I (WE) AGREE TO STRICTLY COMPLY WITH AND ABIDE BY THE RULES AND REGULATIONS SET FORTH BY PERSONNEL OF DICK POWERS VOLLEYBALL AND POWERS HUMAN DEVELOPMENT.
7. I (WE) HEREBY GIVE PERMISSION FOR USE OF NAMES, STATEMENTS, AND PICTORIAL HARD COPY AND ELECTRONIC REPRESENTATIONS INCLUDING PICTURES AND VIDEOS UTILIZED FOR PROMOTION OF SAID CAMPS, INTERNET PUBLICATION OF VOLLEYEYE VIDEO FOOTAGE, CLINICS, PRIVATE TRAINING, AND POWERS RECRUITING SERVICE. I (WE) WAIVE ALL CLAIMS FOR COMPENSATION FOR SUCH USE.
8. I (WE) WILL PURSUE NO ADVERSARIAL LEGAL ACTION, CIVIL OR CRIMINAL, DIRECTLY OR INDIRECTLY RELATED TO PARTICIPATION IN TRAINING AND ASSOCIATION WITH DICK POWERS/POWERS HUMAN DEVELOPMENT/DICK POWERS VOLLEYBALL/POWERS VOLLEYBALL CLUB/GUTS VOLLEYBALL CAMPS/TRAINING PROGRAMS/ASSOCIATED
PERSONNEL/HOST INSTITUTIONS, FACILITIES, AND PERSONNEL.
**SHOULD THE PARTICIPANT BE LESS THAN TWENTY-ONE YEARS OF AGE, PARENT(S)/GUARDIAN(S) WILL DOCUMENT THE FOLLOWING CONDITIONS WITH SIGNATURE(S).
I (WE) HAVE PROVIDED THE OPPORTUNITY FOR EXPLANATION AND CLARIFICATION OF SET FORTH CONDITIONS TO THE ABOVE SIGNED CAMP/TRAINING/CLUB PROGRAM PARTICIPANT AND DOCUMENT APPROVAL AND CONSENT TO ANY AND ALL STIPULATED CONDITIONS SET FORTH.
Step 2:
Step #3...Read Below Legal Waiver Form and Check at Least One Consent Box at Form's End
First name of Athlete:
Last name of Athlete:
Grade in Fall 2021:
If collegiate athlete,
please use 13 for 1st year, 14 for Soph year, etc.
School/College
Birthdate MM-DD-YY:
Street Address:
City:
State:
Zip Code:
Parent1 First name:
Parent1 Last name:
Parent1 Day Phone:
Parent1 Cell Phone:
Parent1 Email:
Parent1 Other:*
Parent2 First name:
Parent2 Last name:
Parent2 Cell Phone:
Parent2 email:
Parent2 Other:*
* Include other email addresses here - carpool helpers, grandparents, coaches, etc.
* Include other email addresses here - carpool helpers, grandparents, coaches, etc.
Emergency Contact Information
Emgcy 1 First name:
Emgcy 1 Last name:
Emgcy Day Phone:
Emgcy Cell Phone:
- Please look for reply information from email address: coachpowers@outlook.com.
- Also, look for text alert(s) from 260 267 5119 to let you know of "Email in your inbox".
- Your confirmation email will provide further information including: Preparation Information, Location, Fee Structure, and Guidance.
- Please add coachpowers@outlook.com to your approved email contacts.
- For any reason, if you do not receive email and text alert(s) within 24 hours of your registration, please text or call DPV @ 260 267 5119
Emgcy 2 First name:
Emgcy 2 Last name:
Emgcy 2 Day Phone:
Emgcy 2 Cell Phone:
Step 4: Please click the green "Click to Register" button below.
Your information will be sent only by selecting this button - Thank You!
Parent2 Day Phone:
Step # 1: Please complete Athlete and Caregiver(s) Information - This Information is Not Shared
Please Click Any or All of the boxes for dates that You Care to Attend. Thank You ! Make Checks Payable to Dick Powers Volleyball
Mail to: 140 Lane 101FA Jimmerson Lake Angola, IN 46703
FINE PRINT:
- OK - DPV is kind of NOS, "New Old School." We/DP start learning names of athletes and parents when we see your checks received for training. Please do send your registration fees payable to DPV to DPV 140 Lane 101FA Jimmerson Lake Angola, IN 46703-7094
- You will receive a registration confirmation email from coachpowers@outlook.com.
- You will also receive a text: "Email in Your Inbox" from The Dick Powers Volleyball Office Number: 260 267 5119. Please, use this number to text your questions, concerns, and compliments:) Thank You !
