Mississippi Coaches Association: Online Forms
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    • Coaching Record Update & All-Star Player Nomination Forms
    • All-Star Volleyball Acceptance
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2021 Volleyball- Player Participation Packet

  • PLAYER ACCEPTANCE

    Dear 2021 All-Star Volleyball Player,

    Because of your commitment and dedication to excellence in athletics, you have been chosen to play in the 2021 All-Star Volleyball Games. This special honor is extended to only 24 players in the state and my personal congratulations go to you for receiving this recognition. The following information about this year's game may be helpful to you in making your decision to accept this invitation:

    The games will be played Wednesday, July 14, 2021, beginning at 6:00 p.m. at Millsaps College, Jackson, MS

    Players will report to the Hangar Dome at Millsaps College, Jackson, MS by 12:30 on Tuesday, July 13, and will be housed at Millsaps College on Tuesday night.

    Secondary insurance will be provided.

    Players will bring their high school uniforms to wear in the games

    Players must be rising seniors for the 2021-2022 school year.

    Physical exams will be administered by the medical staff of MS Sports Medicine upon arrival. Your participation depends upon your passing this examination satisfactorily. As stated in the player selection guidelines, players cannot participate if pregnant.

    Players are asked to sell a minimum of $300 in ads for the All-Star Game program. (In order to receive a commission check, players must sell at least $300 in ads - 20% commission will be paid on ad sales of $300 and above.)

    Check your calendar to be sure you have no conflict with the reporting date & game date. The five forms listed below are included with this packet - please complete each form, have them signed where indicated, and submit them no later than Wednesday, November 18, 2020.

    1. Agreement to Play

    2. Personal Information Form

    3. Consent to Medical Treatment and Insurance Coverage Questionnaire

    4. Player General Release

    5. Statement of Understanding and Notice of Insurance Coverage

    6. Copy of your current school physical (should be on file at your school) by mail to M.A.C.
    P.O. Box 1194, Clinton, MS 39060, or by fax to 601-924-3050.

    All participants will be expected to abide by current COVID-19 regulations & guidelines.

    Ad sales directions are included with these forms. Pease make copies of the Ad contract Form to use in selling your ads. If you have any questions, please contact sangelo@mscoaches.com.

    I look forward to meeting all of you and working with you to make this game a memorable event for all - players, coaches and fans.

  • PLAYER PERSONAL INFORMATION FORM

    Please list all honors received in sports and other school activities, and be specific. List the honor and the year, and if the award is not from your school, list the organization giving you the award and the name of the award (i.e., Hattiesburg Optimist Club Student of the Year, 2016).

  • CONSENT TO MEDICAL TREATMENT

  • Part III

  • Select all that apply:
  • PLAYER GENERAL RELEASE

    We, the undersigned parent(s) or legal guardian(s) of the player listed above (hereinafter “Player”), a member of the 2021 All-Star Volleyball Team, for in the consideration of our daughter participating in such tournament and in further consideration of the fact that the Mississippi Association of Coaches will house and feed my daughter from July 13 through July 14, 2021 do hereby release the Mississippi Association of Coaches, its officers, directors, members and any other agents or representatives (hereinafter “Releasees”) and hereby hold harmless the Releasees against any and all claims, causes of action, demands, costs, expenses, or any other potential actions asserted arising out of or in any way related to or connected with the participation of our daughter in the 2021 All-Star Volleyball Game. We, the undersigned, release the Releasees from any and all claims that may result either from the participation in practices leading up to the 2021 All-Star Volleyball Game or participation in the game, and transportation to or from the game and/or transportation during the week of the game. Moreover, we do hereby grant permission to the Mississippi Association of Coaches, the Host College and its staff (all also referred to herein as “Releasees”) to transport and entertain the above named player during the All-Star activities beginning Tuesday, July 13, 2021, until Wednesday, July 14, 2021, at the close of the All-Star activities at Millsaps College, Jackson, MS. We, the undersigned, release the above named parties, their agents, employees and other related persons, including all other Releasees, from any and all claims which may result from the travel and entertainment of the above named player.

    We also agree that the released parties shall not be responsible for any illness, disease, injury or other occurrence suffered by the player associated with his/her travel, entertainment, participation in practice or in the game, and furthermore agree that there shall be no liability to the Releasees herein for any of the above noted acts.

    By these presents and in consideration above enumerated, we further covenant and agree that we shall forever refrain from instituting any action, pressing, collecting or in any way aiding or proceeding upon any and all claims, causes of action, suits and proceedings of any kind at law or in equity which our daughter or the undersigned ever has, or may have, against any of the Releasees herein arising out of the aforesaid activities, and more particularly participation in practices and the game relating to the 2021 All-Star Volleyball Game, or any other activity relating thereto.

  • STATEMENT OF UNDERSTANDING AND NOTICE OF INSURANCE COVERAGE

    I, the undersigned parent(s) and/or guardian(s) of the athlete listed above, a participant in the 2021 All-Star Volleyball Game, do understand that the insurance coverage provided for all the participants in this game is known as secondary coverage. This specifically means that my personal insurance company’s policy is the primary coverage for my daughter and will be considered primary in the event my daughter suffers an accidental injury requiring medical attention, evaluation and/or treatment during any All-Star Activities from July 13 through July 14, 2021.

    I further understand that the Mississippi Association of Coaches does provide insurance coverage to my daughter, but such coverage is secondary, specifically meaning that such coverage only becomes applicable after my coverage, if any, has first been utilized to cover the expenses and fees for such medical treatment. Moreover, I have been informed that the coverage provided by the Mississippi Association of Coaches may have certain deductions, exclusions and upper limits so as not to provide full coverage to my daughter even if the insurance is utilized after exhausting my personal coverage, if any.

    I further understand that the Mississippi Association of Coaches provides such coverage for the benefit of the participants in the 2021 All-Star Volleyball Game and their parents, and such insurance coverage possibly may not cover all bills, expenses and other costs incurred by the participants while participating in the 2021 All-Star Volleyball Game at Millsaps College, Jackson, MS. Toward that end, I have been placed on notice by the Mississippi Association of Coaches and its representatives that if additional insurance coverage is needed for my daughter, I should provide such insurance at my own expense. I hereby state that the information provided on the Medical Consent form is the correct name, address and policy number of the present health, accident and hospitalization insurance providing coverage for my daughter. If such coverage is changed, lapses or terminates for any reason, I hereby agree to update and supplement the information provided and to ensure that the Mississippi Association of Coaches and its representatives are provided with current information relating to insurance up and through the date of the Game.

  • SIGNATURES

    Your signatures below attest to your understanding of the information collected in this form. An email will be sent with copies of this information.
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