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Waiver Form

The final estimated price is :

If I am not available in the event of emergency, I authorize you to contact the following the person(s):
Medical Information:

Please list any medical conditions/injuries for which you are under a doctor's care or that would prevent you from participating. Parent or Guardian acknowledges by signature below that FVC or VA LLC will be notified of any changes in health status:

I, the undersigned, do hereby authorize that I am able to participate in the programs held by FVC of VA LLC (FJVC) AT 3411 Shannon Park Dr., Fredericksburg, VA 22408. I agree to release, discharge, and hold harmless The Fredericksburg Field House, FVC of VA LLC (FJVC), their officers, agents and employees of and from all causes, liabilities, damages, claims or demands whatsoever on account of injury or accident involving my participation at the facility or in the course of any performance held in connection with FVC of VA LLC (FJVC). I authorize the staff of said corporations to act for me according to their best judgement in an emergency requiring medical attention. In addition, I acknowledge that I am cover by medical insurance listed on file with the FVC of VA LLC (FJVC) organization. It is further understood that FVC of VA LLC (FJVC) does not provide medical insurance covering injuries of any nature incurred during my participation or attendance at 3411 Shannon Park Dr., Fredericksburg, VA 22408, or at any tournaments or other programs at which I represent or participate with FVC of VA LLC (FJVC).


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