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Release of Liability, Waiver of Claims and Indemnity
(To be executed by Individuals over the Age of Majority)
WARNING! By signing this document you will waive certain legal rights. Please read carefully
1.
This is a binding legal agreement; therefore clarify any questions or concerns before signing. As an Individual
member in the sport of volleyball and/or the events, programs, competitions, travel, and activities organized,
operated or conducted and/or sanctioned by Volleyball Alberta (collectively the Activities”), the undersigned
acknowledges and agrees to the following terms:
Disclaimer
2.
Volleyball Alberta, member clubs, and all the respective, directors, officers, committee members, members,
employees, coaches, volunteers, referees, participants, agents, sponsors, and representatives, and owners/operators
of the event facilities (collectively the “Organization”) are not responsible for any injury, personal injury, damage,
property damage, expense, loss of income or loss of any kind suffered by the Individual during, or as a result of, the
Activities, caused in any manner whatsoever including, but not limited to, the negligence of the Organization.
I have read and agree to be bound by paragraphs 1 and 2
Description and Acknowledgement of Risks
3. I understand and acknowledge that
a) The Activities have foreseeable and unforeseeable inherent risks, hazards and dangers that no amount of care,
caution or expertise can eliminate, including without limitation, the potential for serious bodily injury, permanent
disability, paralysis and loss of life; and
b) The Organization has a difficult task to ensure safety but it is not infallible. The Organization may be unaware of
my fitness or abilities, may give incomplete warnings or instructions, and the equipment being used might
malfunction.
4. In consideration of my involvement with the Activities, I hereby acknowledge that I am aware of the risks, dangers
and hazards associated with or related to the Activities. The risks, dangers and hazards include, but are not limited
to:
a) The sport of volleyball;
b) Executing strenuous and demanding physical techniques;
c) The failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment;
d) Physical contact with other Individuals, participants, spectators, equipment and hazards;
e) Contact with, colliding with, or being struck by the volleyball, net, poles, benches, equipment, or other
Individuals, participants, or spectators
f) Spinal cord injuries which may render me permanently paralyzed;
g) Serious injury to virtually all bones, joints, ligaments, muscles, tendons and other aspects of my body or to my
general health and well-being;
h) Abrasions, sprains, strains, fractures, or dislocations;
i) Concussion or other head injuries, including but not limited to, closed head injury or blunt head trauma;
j) Failure to act safely or within my own ability or within designated areas;
k) Negligence of other persons, including other Individuals, spectators, participants, or employees;
l) Travel to and from the event which is an integral part of the Organization’s Activities; and
m) Negligence on the part of the Organization, including failure on the part of the Organization to take reasonable
steps to safeguard or protect me from the risks, dangers and hazards associated with my involvement in the
Activities.
I have read and agree to be bound by paragraphs 3 and 4
Individual's Name:
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Terms
5. In consideration of my involvement in the Activities, I agree:
a) That my mental and physical condition is appropriate and I assume all risks related to my mental or physical
condition;
b) To comply with the rules of the facility and equipment;
c) That if I observe an unusual significant hazard or risk, I will remove myself from the area and bring such to the
attention of an Organization representative immediately;
d) That the Organization may not provide full health, accident, disability, hospitalization, personal property or other
insurance for me and I affirm that I have ascertained appropriate insurance to protect myself; and
e) The risks associated with the Activities are increased when I am impaired and I agree not to become involved if
impaired in any way.
Release of Liability and Disclaimer
6. In consideration of my involvement in the Activities, I agree:
a) That the sole responsibility for my safety remains with me;
b) To ASSUME all risks arising out of, associated with or related to my involvement;
c) That I am not relying on any oral or written statements made by the Organization or its agents, whether in a
brochure or advertisement or in individual conversations, to agree to be involved in the Activities;
d) To WAIVE any and all claims that I may have now or in the future against the Organization;
e) To freely ACCEPT AND FULLY ASSUME all such risks and possibility of personal injury, death, property damage,
expense and related loss, including loss of income, resulting from my involvement in the activities, events and
programs of the Organization; and
f) To FOREVER RELEASE the Organization from any and all liability for any and all claims, demands, actions, damages
(including direct, indirect, special and/or consequential), losses, actions, judgments, and costs (including legal fees)
(collectively, the “Claims”) which I have or may have in the future, that might arise out of, result from, or relate to
my involvement in the Activities, even though such Claims may have been caused by any manner whatsoever,
including but not limited to, the negligence, gross negligence, negligent rescue, omissions, carelessness, breach of
contract and/or breach of any statutory duty of care of the Organization;
g) That negligence includes failure on the part of the Organization to take reasonable steps to safeguard or protect
me from the risks, dangers and hazards associated with the Activities; and
h) This release, waiver and indemnity is intended to be as broad and inclusive as is permitted by law of the Province of
Alberta and if any portion thereof is held invalid, the balance shall, notwithstanding, continue in full legal force and
effect.
Jurisdiction
7. I agree that in the event that I file a lawsuit against the Organization, I agree to do so solely in the province of
Alberta, Canada and further agree that the substantive law of Alberta will apply without regard to conflict of law
rules. I further agree that if any portion of this agreement is found to be void or unenforceable, the remaining
document shall remain in full force and effect.
I have read and agree to be bound by paragraphs 5-7
Acknowledgement
8. I acknowledge that I have read and understand this agreement, that I have executed this agreement voluntarily, and
that this agreement is to be binding upon myself, my heirs, spouse, children, parents, guardians, next of kin,
executors, administrators and legal or personal representatives. I further acknowledge by signing this agreement I
have waived my right to maintain a lawsuit against the Organization on the basis of any claims from which I have
released them herein.
_______________________________ ______________________________ _____________________
Name of Individual (print) Signature of Individual Date
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Volleyball Alberta Policy Acknowledgement Form
As an individual affiliated with Volleyball Alberta for the current season (September 1 – August 31), I agree to adhere to
and abide by Volleyball Alberta’s policies and procedures, which include:
Code of Conduct and Ethics
Discipline and Complaints Policy
Scouting and Recruiting Policy
Privacy Policy
Refund and Cancellation Policy
Screening Policy
Concussion Policy and Protocol
Use of Personal Information
Social Media Guidelines
Appeal Policy
Transgender Inclusion Policy
I have the following role with Volleyball Alberta for the ____________________ season (check as many as apply):    
I also recognize that I must adhere to additional standards particular to my role(s), which are described in the Code of
Conduct and Ethics.
______________________ ______________________ _________________
Name of Individual Signature Date
_____________________ ______________________ _________________
Parent/Guardian Name (If Individual is 17 or under) Parent/Guardian Signature Date
__________________________________________________________________________________________________
Parent’s/Guardians of Individual’s who are younger than 18:
Parents/Guardians must agree on behalf of their minor as well as accept the policies on their own behalf in their role as
a parent/guardian.
As a parent/guardian affiliated with Volleyball Alberta for the _____________ Season (September 1– August 31), I agree
to adhere to and abide by Volleyball Alberta’s policies and procedures listed above. I also recognize that I must adhere
to additional standards particular to my role(s), which are described in the Code of Conduct and Ethics.
_____________________ ________________________________ _________________
Parent/Guardian #1 Name Parent/Guardian #1 Signature Date
_____________________ ________________________________ _________________
Parent/Guardian Name Parent/Guardian #2 Signature Date
Coach:
Director/Volunteer:
Athlete:
Committee Member:
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Pre-Season Concussion Education Sheet
WHAT IS A CONCUSSION? A concussion is a brain injury that can’t be seen on x-rays, CT or MRI scans. It affects the way
an athlete thinks and can cause a variety of symptoms.
WHAT CAUSES A CONCUSSION? Any blow to the head, face or neck, or somewhere else on the body that causes a
sudden jarring of the head may cause a concussion. Examples include getting body-checked in hockey or hitting one’s
head on the floor in gym class.
WHEN SHOULD I SUSPECT A CONCUSSION? A concussion should be suspected in any athlete who sustains a significant
impact to the head, face, neck, or body and reports ANY symptoms or demonstrates ANY visual signs of a concussion. A
concussion should also be suspected if an athlete reports ANY concussion symptoms to one of their peers, parents,
teachers, or coaches or if anyone witnesses an athlete exhibiting ANY of the visual signs of concussion. Some athletes
will develop symptoms immediately while others will develop delayed symptoms (beginning 24-48 hours after the
injury).
WHAT ARE THE SYMPTOMS OF A CONCUSSION? A person does not need to be knocked out (lose consciousness) to
have had a concussion. Common symptoms include:
Headaches or head pressure
Feeling slowed down
Difficulty reading
Dizziness
Easily upset or angered
Difficulty learning new information
Nausea and vomiting
Sadness
Not thinking clearly
Blurred or fuzzy vision
Nervousness or anxiety
Difficulty working on a computer
Sensitivity to light or sound
Feeling more emotional
Having a hard time falling asleep
Balance problems
Sleeping more or sleeping less
Feeling tired or having no energy
WHAT ARE THE VISUAL SIGNS OF A CONCUSSION? Visual signs of a concussion may include:
Lying motionless on the playing surface
Blank or vacant stare
Slow to get up after a direct or indirect hit to the head
Clutching head
Balance, gait difficulties, motor incoordination, stumbling, slow labored
movements
Facial injury after head trauma
Disorientation or confusion or inability to respond appropriately to questions
WHAT SHOULD I DO IF I SUSPECT A CONCUSSION? If any athlete is suspected of sustaining a concussion during sports
they should be immediately removed from play. Any athlete who is suspected of having sustained a concussion during
sports must not be allowed to return to the same game or practice. It is important that ALL athletes with a suspected
concussion undergo medical assessment by a medical doctor or nurse practitioner, as soon as possible. It is also
important that ALL athletes with a suspected concussion receive written medical clearance from a medical doctor or
nurse practitioner before returning to sport activities.
WHEN CAN THE ATHLETE RETURN TO SCHOOL AND SPORTS? It is important that all athletes diagnosed with a
concussion follow a stepwise return to school and sports-related activities that includes the following Return-to-School
and Return-to-Sport Strategies. It is important that youth and adult student-athletes return to full-time school activities
before progressing to stage 5 and 6 of the Return-to-Sport Strategy.
Canadian Guideline on Concussion in Sport | Pre-Season Concussion Education Sheet www.parachutecanada.org/concussion
www.volleyballalberta.ca
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Return-to-School Strategy
1
Aim
Activity
Goal of each step
Daily activities at home
that do not give the
student-athlete
symptoms
Typical activities during the day as long as they do not
increase symptoms (i.e. reading, texting, screen time).
Start at 5-15 minutes at a time and gradually build up.
Gradual return to typical
activities
School activities
Homework, reading or other cognitive activities
outside of the classroom.
Increase tolerance to cognitive
work
Return to school part-
time
Gradual introduction of schoolwork. May need to start
with a partial school day or with increased breaks
during the day.
Increase academic activities
Return to school full-
time
Gradually progress
Return to full academic activities
and catch up on missed school
work
Volleyball-Specific Return-to-Sport Strategy
1
Stage
Aim
Activity
Goal of each step
1
Symptom-limiting
activity
Daily activities that do not provoke symptoms
Gradual re-introduction of
work/school activities
2
Light aerobic
activity
Walking or stationary cycling at slow to medium pace. No
resistance training
Increase heart rate
3
Sport-specific
exercise
Running drills. No head impact activities
Add movement
4
Non-contact
training drills
Harder training drills, i.e. attacking drills. May start
progressive resistance training
Exercise, coordination and
increased thinking
5
Full contact
practice
Following medical clearance and complete return to school.
Restore confidence and assess
functional skills by coaching staff
6
Return to sport
Normal game play
1 Source: McCrory et al. (2017). Consensus statement on concussion in sport the 5th international conference on concussion in sport
held in Berlin, October 2016. British Journal of Sports Medicine, 51(11), 838-847. http://dx.doi.org/10.1136/bjsports-2017
HOW LONG WILL IT TAKE FOR THE ATHLETE TO RECOVER? Most athletes who sustain a concussion will make a
complete recovery within 1-2 weeks while most youth athletes will recover within 1-4 weeks. Approximately 15-30% of
patients will experience persistent symptoms (>2 weeks for adults; >4 weeks for youth) that may require additional
medical assessment and management.
HOW CAN I HELP PREVENT CONCUSSIONS AND THEIR CONSEQUENCES? Concussion prevention, recognition and
management require athletes to follow the rules and regulations of their sport, respect their opponents, avoid head
contact, and report suspected concussions. To learn more about concussions, please visit:
www.parachutecanada.org/concussion
The following signatures certify that the athlete and his/her parent or legal guardian have reviewed the above
information related to concussion.
___________________________________ ____________________________ ______________
Printed name of Individual Signature of Individual Date
___________________________________ ____________________________ ______________
Printed name of parent (If Individual is 17 or under) Signature of parent Date
Canadian Guideline on Concussion in Sport | Pre-Season Concussion Education Sheet www.parachutecanada.org/concussion
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