USA VOLLEYBALL - 2014-2015 INDIVIDUAL MEMBERSHIP FORM

USA VOLLEYBALL - 2014-2015 INDIVIDUAL MEMBERSHIP FORM
MEMBERSHIP APPLICATION
LEGAL FIRST NAME:
MI:
LEGAL LAST NAME:
Check box if name has changed in the past year. If yes, please provide previous name: __________________________________________________________________________________________________
ADDRESS:
CITY:
STATE:
GENDER:
Male
Female
ZIP CODE:
BIRTHDATE:
E-MAIL:
(USA Volleyball does NOT provide e-mail addresses to third parties)
JUNIORS ONLY:
GRADE
HOME PHONE:
HIGH SCHOOL GRAD YEAR
CELL PHONE:
WORK PHONE:
ACKNOWLEDGEMENT/USE AGREEMENT
I agree that I will abide by the rules and guidelines regarding club affiliation as established by the Regional Volleyball Association in which I am applying for membership.
I hereby agree to be filmed, videotaped and photographed, and to have my name, image, picture, likeness, voice and biographical information otherwise recorded, in any media, during USA Volleyball (USAV) and/or its Regional Volleyball
Association (RVA) sanctioned events, by USA
I hereby grant USAV/RVA, with no financial or other compensation due to me, full right and license to use, and to authorize third parties to use, in all media, the Footage for: (1) news and information purposes, (2) promotion of the specific
competition(s) in which I compete, (3) promotion of the Sport, and (4) promotion of USAV/RVA, provided that, in no event may the USAV/RVA use or authorize the commercial use of the Footage in any manner that would imply my endorsement of
any company, product, or service, without my written permission.
I hereby certify that the information provided is being done directly by myself or by me, as the legal guardian representing a minor, and that it is true and accurate to the best of my knowledge. I also understand and agree that incomplete or false
information is grounds for denial of membership.
_________________________________________________________________________________________________________ Date signed: __________________________________________________
If applicant is under 18 years of age:
________________________________________________________________________________ Parent/Guardian E-Mail:
Parent/
: ___________________________________________________________________________________________________________________ Date signed: ___________________________________________________
USA VOLLEYBALL WAIVER AND RELEASE OF LIABILITY
articipation in a volleyball event can cause potential death, serious injury, or property damage. With a full understanding
of the potential risks, I HEREBY ASSUME THE RISKS OF PARTICIPATING OR OFFICIATING IN A VOLLEYBALL EVENT.
I hereby take the following action for myself, my executors, administrators, heirs, next of kin, successors and assigns: a) I WAIVE, RELEASE, AND DISCHARGE from any and all claims or liabilities for death or personal injury or damages of any kind,
EXCEPT THAT WHICH IS THE RESULT OF GROSS NEGLIGENCE AND/OR WANTON MISCONDUCT OF PERSONS OR ENTITIES LISTED BELOW, which arise out of or relate to my traveling to and from or my participation in any volleyball
event, THE FOLLOWING PERSONS OR ENTITIES: USA Volleyball and its Regional Volleyball Associations, tournament directors, sponsors, and the officers, directors, employees, representatives, and agents of any of the above; b) I AGREE NOT
TO SUE any of the persons or entities listed above for any of the claims or liabilities that I have waived, released or discharged herein; and c) I INDEMNIFY AND HOLD HARMLESS the persons or entities mentioned above from any claims made or
liabilities assessed against them as a result of my actions.
Date signed:
_______________________________________________________________________________________________________________________________
Date signed:
USA VOLLEYBALL CODE OF CONDUCT
THEFOLLOWINGACTIONSAREPROHIBITED:
1.
Violation of any anti-doping policies, protocols or procedures as defined by the International Olympic Committee (IOC), World Anti-Doping Agency (WADA), Federation Internationale de Volleyball (FIVB), US Anti-Doping Agency (USADA)
or the United States Olympic Committee (USOC). Violations of this provision will be adjudicated only by USADA or the proper anti-doping authority, not USA Volleyball (USAV).
2.
3.
4.
5.
6.
7.
8.
Possession, consumption or distribution of alcohol and/or tobacco if illegal or in violation of USA Volleyball (USAV) or Regional Volleyball Association (RVA) policy.
USAV policy prohibits the possession, consumption or distribution of alcohol and/or tobacco by anyone registered as a junior volleyball player at the event venue of any USAV/RVA sanctioned junior event.
Use of a recognized identification card by anyone other than the individual described on the card.
Physical damage to a facility or theft of items from a room, dormitory, residence or other person. (Restitution will be part of any penalty imposed.)
Possession of fireworks, ammunition, firearms, or other weapons or any item or material which by commonly accepted practices and principles would be a hazard or harmful to other persons at USAV/RVA sanctioned events.
Any action considered to be an offense under Federal, State or local law ordinances.
Violation of the specific policies, regulations, and/or procedures of the USAV, RVA or the facility used in conjunction with a sanctioned event. (It is the responsibility of the individual to be familiar with applicable specific policies,
regulations and procedures.)
Conduct which is inappropriate as determined by comparison to normally accepted behavior.
9.
10.
Physical or verbal intimidation of any individual.
11.
Actions that will be detrimental to USAV or the RVA.
USAVOLLEYBALL DISCIPLINARY POLICY:
Infraction
When Occurred
Suggested Maximum Penalty
First
Before or during event
Individual disqualified (if person is a junior, he/she will be sent home as soon as possible and parent or guardian notified). The individual may be
declared ineligible for USAV registration or RVA membership for one year starting from the date of infraction.
The individual may be declared ineligible for USAV registration or RVA membership for one year starting from the date of infraction.
Second
Before or during event
After event concludes
After event concludes
Third
NOTE :
Individual disqualified (if person is a junior, he/she will be sent home as soon as possible and parent or guardian notified). The individual may
be declared ineligible for USAV registration or RVA membership for two years starting from the date of infraction.
The individual may be declared ineligible for USAV registration or RVA membership for two years starting from the date of infraction.
Individual may be declared ineligible for USAV registration or RVA membership for the remainder of his/her lifetime.
Major misbehavior (e.g. verbal orphysical abuseof a child, sexual harassment, etc.) may subject the violator to a lifetime ineligibilityfor USAV registrationor
RVA membership after the first infraction.
Penalties are only applied after affording the participant due process may be required by the Ted Stevens Olympic and Amateur Sports Act (TSOASA), USOC, USAV, and RVA. Appeals, other thanfordoping violations, may bemade
in accordance with procedures set forth in the bylaws and operating codes of USA Volleyball and the RVA as printed in the current Official USA Volleyball Guide and RVA Handbook, respectively.
I have read and understand the USA Volleyball Code of Conduct and Disciplinary Policies
I agree and consent to abide by the USA Volleyball Code of Conduct and Disciplinary Policies and other region specific code of conducts and/or disciplinary policies.
I understand that, if I violate the USAV and/or RVA Codes of Conduct, I might be subject to disciplinary action in accordance with USAV and/or RVA Disciplinary Policies.
Date signed:
______________________________________________________________________________________________________ Date signed: