Student Registration Please fill out the information below to register: HiddenClass HiddenLocation Tryout Prep-n-Play / Camp 5 -Group 1: Aug 23, 24, 25, 26 Price: If the above is not the session you wish to register for, please go back and click on the button below the correct session. See available programs here.No Class Selected Go back and click on the registration button below the session you want to register for. See available programs here.Class Location Time Student InformationStudent's Name* First Last Parent's Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent's Phone*Emergency Phone*Parent's Email* Student's Email Student Date of Birth* MM slash DD slash YYYY Current Student Age* School* Grade* Shirt Size* How long have you been playing volleyball?*Beginner (less than 1 year)Intermediate / Advanced (1+ years)Have you been on a Travel Team? If so, what's the team name and how many years? Health Screening QuestionnaireHow would you describe your present state of health?*Very WellHealthyUnhealthyIllPlease check those conditions that apply to the student athlete Prescription medications Over-the-counter medications or supplements Allergies Amenorrhea Anemia Anxiety Arthritis Asthma Celiac Disease Chronic Sinus Condition Constipation Crohn's Disease Depression Diabetes Intestinal Problems Gastroesophageal Reflux Disease High Blood Pressure Hyper/Hypo-thyroidism Hypoglycemia Insomnia Major Surgeries Past Injuries Chest discomfort with exertion Unreasonable breathlessness Dizziness, fainting, or blackouts Musculoskeletal problems Diabetic / medicine to control blood sugar Include details about conditions, injuries, or medications in the text area belowPlease list any other surgeries, injuries, medications, or conditions that need to be mentioned for the safety and well being of your daughter or participant. Type NONE if not applicableThe more we know the better we can help them.Informed ConsentI hereby consent to voluntarily participate and assumption of risk in the HOT Volleyball Training Program with Traci Edwards and her assistance. My permission to participate in the exercise sessions and functional exercise techniques is voluntarily. I understand that I am free to stop participation at any point I so desire. I have read this form and I understand the exercise sessions risk that I will perform and the attended risk and discomfort. Knowing these risks and discomforts and having an opportunity to ask questions that have been answered to my satisfaction, I consent to participate in this program.Do you agree and consent to the above statement?* I agree Payment InformationTotal Due $0.00 How would you like to pay?* Online via credit card Online via Zelle Online via Venmo Online via Chase Pay Mail a Check Zelle: traciedwards@me.com or 201-745-1451Venmo: @HOTvolleyballNYCChase Pay: traciedwards@me.com or 201-745-1451Please make payable to "Traci Edwards" & sent to: HOT Volleyball NYC Attn: Traci EdwardsP.O. Box 65, Cliffside Park, NJ 07010Credit CardCard Details Cardholder Name Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code NameThis field is for validation purposes and should be left unchanged.
