La Porte, IN

-Dunes Camp Liability Form

Dunes Volleyball Club

Liability Form

 Name: ___________________________

 Address: _______________________

 Phone: ________________________

 Email address _____________________

 School ________________  Grade___________

 Height:  ________________  Position: ___________

Date of Birth: _______________________


 I hereby give ________________________          (Student’s Name) permission to participate in the Dunes Volleyball Events & Camps. I will not hold the sponsor of the camp, the Dunes Events Center,  Dunes Volleyball Club, or their individuals liable for any injuries that may occur. I take responsibility for any injuries and medical emergencies that may occur to the student listed above at this camp I have adequate hospitalization insurance to cover any injuries that may occur.


Parent/Guardian Signature                _________________________________

Date : _____________________: