November 14th Clinic Registrations

November 14th Clinic Registrations

Location: Lakeland Christian School Gymnasium (1111 Forest Park St. Lakeland FL 33803)
Parent/Guardian Information
Parent/Guardian Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Primary Email
*Important camp information and updates will be sent to the email address on file.
Athlete Information
Athlete's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Athlete's Date of Birth

MonthDayYear
Athlete's Age
Volleyball Experience
Waivers and Releases
Release statement: The undersigned parent or legal guardian of the athlete/athletes listed above hereby consents and authorizes participation in West Polk Volleyball Academy's Volleyball Camp. I understand that my athlete/athletes will be in drills that require physical exertion and acknowledge that there is a risk of personal injury to my athlete/athletes. In consideration for WPVA accepting the above names athletes into the Volleyball Camp, I do hereby for myself, my spouse, and my athletes forever discharge West Polk Volleyball Academy, its associates, directors, affiliates, and either in law or equity, arising from or as a result of my athlete/athletes participation in WPVA Camp.
Name

First NameLast Name
Signature
Photo/Video Waiver: I knowingly give consent for the release of any photographic images that may be taken during my child’s participation in WPVA'S Volleyball Camp for the use by West Polk Volleyball Acadmey for its publications, promotional materials, social media, advertisement. I hereby grant permission to the rights of my child’s image, likeness and without payment or any other consideration. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.
Name

First NameLast Name
Signature
Payment Information
Select the clinic(s) you are wanting to register for.
Other Payment Types
Mailing Address: 4419 Morgan Creek Pkwy. Lakeland FL 33811

Coupon Code is CLINIC if registering for 2 clinics on 11/14/26

Athlete Registration (Venmo)

ONLY CHECK THIS BOX if paying VENMO, if paying by check/cash advance to submit button below

$56.00 Quantity

Athlete Registration (PayPal)

ONLY CHECK THIS BOX if paying by PAYPAL, if paying by check/cash advance to submit button below

$58.00 Quantity

Enter coupon

Total

Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty:

November 14th Clinic Registrations

Parent/Guardian Information

Athlete Information

Waivers and Releases

Payment Information

Coupon Code is CLINIC if registering for 2 clinics on 11/14/26

Payment Methods