Welcome to the online form for the Juventus Academy Saint Louis AND Panathinaikos Volleyball Spring 2021 Trivia Night Fundraiser.

Each family is asked to complete the below information for ALL Juve players in your family and submit it by

no later than Monday, April 5, 2021.

EVENT INFORMATION:

>> One ticket gets someone admission in to the event, seating at a COVID safe table, and beverages (water, soda, beer, and wine).

>> Doors open at 6PM; Trivia starts at 7PM

>> This event will be on the futsal court with tables spread out to maxmize social distancing

>> Please review the complete breakdown of the event and all COVID safety measures that have been included throughout every part of the evening.

HOW TRIVIA NIGHT WORKS:

- There are 7 rounds of Trivia, each with a different theme ... all focused on Legends in Entertainment; the final round will have 3 parts

- Each table will turn in an answer sheet at the end of each round; there will be a prize for the winning table (table with the most points) at the end of the event

- Mulligans will be available for purchase if you are stumped for an answer ... when you place your mulligan on the answer line, it is automatically marked as correct :)

Please keep in mind the following when completing the form:

General SOCCER requirements for the Trivia Night are as follows (2 fundraisers/year):

-- oldest player: sells 4 tickets at $25, or pays a $150 buyout

-- siblings: each sell 2 tickets, or pay a $75 buyout

General VOLLEYBALL requirements for the Trivia Night as as follows (1 fundraiser/year)

-- oldest player: sells 8 tickets at $25, or pays $250 buyout

-- siblings: each sell 4 tickets, or pay a $125 buyout

ALTERNATE OPTIONS TO FULFILL REQUIREMENTS:

-- A raffle basket or other donation of goods/services can be given to replace the full or partial value of the buyout value for their family. Please contact Sue Dittmar to coordinate the donation and valuation.

-- A family can volunteer on the committee to help plan the event. Please contact Sue Dittmar to coordinate how you can help.

-- A family can volunteer time Thursday night, 4/8 to help setup for the event. Setup will begin at 8PM. Please advise Sue Dittmar if you are interested/available to help with this option.

-- A family can utilize a combination of the above and/or tickets to the event ... whatever will work best.

IMPORTANT ITEMS TO NOTE:

The buyout cost is greater than the ticket cost because it includes an estimated average amount of additional funds that would have been raised at the event.

This form should be used by Juventus STL or PAO VB families ONLY ... and should not be given to others to purchase trivia tickets from your family.

PAPER TICKETS WILL NOT BE GIVEN. Tables will be assigned based on feedback provided in your form. Families will get their table # assignment upon arrival at the event.

All funds raised go directly to the Operating Budgets for Juventus Academy Saint Louis and PAO Volleyball. These funds work together with the club fees to cover all club expenses and equipment. They also allow us to offer specialized programs like work-2-play and Juventus Juventini and PAO Panathas. This year, with additional expenses due to COVID, the cost to actually run the club is much greater. These funds will also help to offset the increased COVID related expenses.

** Cost of the ticket includes water, soda, beer, and wine

** Outside food/drink is also allowed

** The full Olympia concession stand will also be open

If you have any questions regarding ticket sales or buyouts, please contact:

Kathy Powers | Vice President
Phone/Text: (314) 570-7857

E-Mail: admin@juventusacademystl.com or kpowers@paousa.com

If you have any questions regarding the event or donations of goods/services/time, please contact:

Sue Dittmar | Fundraiser Chair
Phone/Text: (314) 401-4654

E-Mail: suek@thedittmars.com

FUNDRAISER INFORMATION - by player(s)

Please complete the form below with information for ALL JUVENTUS STL players U8 (2013) -U17 (2004) and ALL PAO VB players in your family. If there are any special circumstances with a player(s), please indicate that information below in the note/comment box.

Player #1 (OLDEST)

Player Name (First & Last) *

TEAM Name(s) *

COACH Name *

Sport *

Soccer

Volleyball

Is this player buying out of the fundraiser? *

NO, we have a Juve SOCCER player and are purchasing FOUR or more tickets and WILL attend

NO, we have a PAO VOLLEYBALL player and are purchasing EIGHT or more tickets and WILL attend

YES: SOCCER buyout: $150.00 (Oldest) - OR - VOLLEYBALL buyout: $250.00 (Oldest) - PAYMENT

YES: SOCCER buyout: $150.00 (Oldest) - OR - VOLLEYBALL buyout: $250.00 (Oldest) - DONATION of goods/services in lieu of a payment (please note details below; requires approval of Fundraiser Chair) YES: SOCCER buyout: $150.00 (Oldest) - OR - VOLLEYBALL buyout: $250.00 (Oldest) - DONATION of goods/services in lieu of a payment (please note details below; requires approval of Fundraiser Chair)

Player #2

Player Name (First & Last)

TEAM Name(s)

COACH Name

Sport

Soccer

Volleyball

Is this player buying out of the fundraiser?

NO, we have a Juve SOCCER player and are purchasing TWO or more ADDITIONAL tickets and WILL attend

NO, we have a PAO VOLLEYBALL player and are purchasing FOUR or more tickets and WILL attend

YES: SOCCER buyout: $75.00 (2nd sibling) - OR - VOLLEYBALL buyout: $150.00 (2nd sibling) - payment

YES: SOCCER buyout: $75.00 (2nd sibling) - OR - VOLLEYBALL buyout: $150.00 (2nd sibling) - DONATION of goods/services/time in lieu of a payment (please note details below; requires approval of Fundraiser Chair) YES: SOCCER buyout: $75.00 (2nd sibling) - OR - VOLLEYBALL buyout: $150.00 (2nd sibling) - DONATION of goods/services/time in lieu of a payment (please note details below; requires approval of Fundraiser Chair)

Player #3

Player Name (First & Last)

TEAM Name(s)

COACH Name

Sport

Soccer

Volleyball

Is this player buying out of the fundraiser?

NO, we have a Juve SOCCER player and are purchasing TWO or more ADDITIONAL tickets and WILL attend

NO, we have a PAO VOLLEYBALL player and are purchasing FOUR or more tickets and WILL attend

YES: SOCCER buyout: $75.00 (3rd sibling) - OR - VOLLEYBALL buyout: $150.00 (3rd sibling) - payment

YES: SOCCER buyout: $75.00 (3rd sibling) - OR - VOLLEYBALL buyout: $150.00 (3rd sibling) - DONATION of goods/services/time in lieu of a payment (please note details below; requires approval of Fundraiser Chair) YES: SOCCER buyout: $75.00 (3rd sibling) - OR - VOLLEYBALL buyout: $150.00 (3rd sibling) - DONATION of goods/services/time in lieu of a payment (please note details below; requires approval of Fundraiser Chair)

NOTES / Special Handling

Comments/Notes

PARENT INFORMATION

MOM Name *

MOM Cell # *

MOM E-Mail Address *

DAD Name *

DAD cell # *

DAD E-Mail Address *

NOTE: IF splitting the fundraiser requirement between parents, please note the details of how it will be split.
NOTE: each parent should submit their own form for their portion if the requirement is being split to allow each parent to pick whatever option works best for their situation.

COVID AGREEMENT

COVID AGREEMENT *

I confirm IF we are purchasing tickets that we will read and review the COVID protocols and safety measures in place for the event prior to purchasing the tickets.

I confirm IF we are purchasing tickets that we agree to have out table complete the COVID agreement and contact sheet that will be on each table and is outlined below.

COVID AGREEMENT:

EACH TABLE will have a COVID agreement form for the table that will need to be completed by everyone at the table.
The COVID agreement will include an acknowledgement that no one at the table:
- Has displayed any symptoms associated with COVID19, including but not limited to a temperature of 100.4 or higher, a persistent cough (not allergy related), or any indications of not being well or healthy.
- Has been DIRECTLY exposed to someone who has tested positive for COVID19 within 14 days prior to the event.
The COVID agreement will also include an acknowledgement that if any of the instances noted below occur AFTER the event, but BEFORE Saturday, 4/17/2021, the impacted person agrees to notify BOTH the Juventus or PAO family who sold them the tickets (or purchased them on their behalf) AND Kathy Powers at KGI via a call/text at 314-570-7857 AND email at admin@juventusacademystl.com or kpopwers@paousa.com. This process will also be posted on the Juventus STL website at juventusacademystl.com and the PAO website at www.paousa.com for easy reference. Here is the list of instances:
- The attendee begins to experience COVID related symptoms
- The attendee learns they were directly exposed to someone between 4/5-4/9 who has tested positive for COVID19.
- The attendee is tested for COVID 19.
- The attendee tests positive for COVID19.
The COVID agreement confirms everyone’s agreement to wear a face mask unless they are at their table.
The COVID agreement will require the table to list the following for each person at the table that will be used for contact tracings if needed:
- Signature (excluding minors)
- Printed Name (with age if it is a minor)
- Cell Phone (Parent phone numbers should be used for minors; each adult should have their own phone number listed, and not use one phone number for multiple adults)
The COVID agreement confirms their understanding that KGI, Juventus Academy Saint Louis, and/or PAO Volleyball will utilize the contact information listed on the form for contact tracing purposes is needed.
The COVID agreement confirms their understanding that if Juventus STL PAO Volleyball or is advised of potential COVID notifications, KGI will review the details with the St Charles County Department of Public Health to determine the next steps.

FUNDRAISER ORDER SUMMARY

Please confirm your selected fundraiser option *

IF you are purchasing tickets .. please indicate which Juve STL or PAO VB team you would like your table grouped with for the event? (tables are grouped together by team/sport) - please enter NA if paying the buyout and not attending *

Please list name(s) you would like on your table reservation. *

TICKET Agreement *

I acknowledge that IF I am purchasing tickets, I will have people in attendance at the event to use the tickets.

I confirm that IF I am purchasing tickets, I understand tables are limited due to COVID protocols requiring extra distance between tables. I am purchasing the tickets with the assurance that people will be attending the event.

I confirm that IF I am purchasing tickets, I will make sure everyone who is attending the event is not in violation of the COVID health check criterion outlined on the COVID agreement (outlined in the event protocols) and mirrors the players training health screening.

Table options *

I understand that all tables will be setup with 8 chairs unless I indicate more are needed due to my ticket purchases. I understand that if this is the case, my table will be pulled out from the normal socially distanced format to provide extra spacing from other tables.

I understand tables are limited due to the need to spread them out for social distancing, BUT we are only purchasing FOUR tickets and DO NOT WANT TO BE PAIRED WITH ANOTHER FAMILY OF FOUR FROM OUR TEAM

I understand tables are limited due to the need to spread them out for social distancing, BUT we are only purchasing FOUR tickets and WOULD like to be paired with the following families while still being comfortable remaining within COVID guidelines. I understand tables are limited due to the need to spread them out for social distancing, BUT we are only purchasing FOUR tickets and WOULD like to be paired with the following families while still being comfortable remaining within COVID guidelines.

FUNDRAISER PAYMENT SUMMARY

Payment Authorization (please select the option that applies to you) *

I acknowledge that I owe Karidis Group International (KGI - parent company for Juve STL and PAO VB) for the amounts noted above, and authorize an automatic debit as payment from the below provided account.

I acknowledge that I owe Karidis Group International (KGI - parent company for Juve STL and PAO VB) for the amounts noted above, but have made the following arrangements in lieu of payment to satisfy our fundraiser requirement. I acknowledge that I owe Karidis Group International (KGI - parent company for Juve STL and PAO VB) for the amounts noted above, but have made the following arrangements in lieu of payment to satisfy our fundraiser requirement.

TOTAL PAYMENT DUE FOR TICKETS PURCHASED: *

TOTAL BUYOUT PAYMENT: *

TOTAL AMOUNT TO BE PAID (tix and buyouts) *

I would like my payment to be deducted using the following type of account and have entered the account details below: *

CHECKING

SAVINGS

DEBIT/CREDIT CARD (5% fee applies)

CHECKING / SAVINGS INFORMATION

eCheck confirmation *

I understand that IF I elect to pay via eCheck from my checking/savings account that I will not have any additional fees added to my ticket cost.

I understand IF I elect this option, my payment will show on my statement as KARIDIS GROUP, the parent company of Juventus Academy Saint Louis

Name of Bank

Account Holder Name

9 digit Routing #

Bank Account #

Billing zip code

Account Holder Cell

DEBIT / CREDIT CARD INFORMATION

Card Processing fee confirmation *

I understand and approve that IF I elect to remit payment via a debit/credit card, a 5% card processing fee will be added to my total. I understand the amount will run as one total payment with the fee included.

I understand IF I elect this option, my payment will show on my statement as KARIDIS GROUP, the parent company of Juventus Academy Saint Louis

Credit Card Type

Name on Card

Debit/Credit Card #

Expiration Date

Security Code

Billing zip code

Card Holder Cell

PAYMENT AUTHORIZATION

Please read and sign: *

By signing this form, I authorize Juventus Academy Saint Louis to process my payment via the payment method noted above, for the amount indicated, and acknowledge that I will be responsible for bank fees if the payment is returned and is unable to be processed.

Enter the word in the image *
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Electronic Signature (please type first and last name) *

Date (mm-dd-yyyy) * +

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