Jersey Athlete
Sports Group

spring dynamites registration
Player Name: *
D.O.B: *
Parent Names: *
Cell Phone #: *
Home Phone #:
email: *
Secondary email:
Address: *
Medical Conditions?:

By submitting this form, I give my permission for my son/daughter to (1) participate in any Jersey Athlete training program either team or individual (2) tryout for a team determined by age, grade, and gender, (3) be transported to/from any competition or event associated with Jersey Athlete or (4) receive reasonable emergency medical treatment or be transported to the hospital to receive same. My child is current with vaccinations. I understand that I am responsible for my own and my child’s conduct. I also understand that soccer is a contact sport and my child is at risk for injury while playing. As such, I agree to let my child participate in soccer and am willing to assume these risks. I confirm that my child is capable of participating in soccer and that s/he is in good physical condition. In addition to giving full consent to my child’s participation, I waive release and hold harmless Jersey Athlete, its members, coaches, and representatives for any injury that may be suffered by my child. I grant permission for my child to receive emergency medical treatment. I grant Jersey Athlete permission to use photographic images of my child in its promotional activities. By submitting this form, I am aware I am bound by the terms & conditions of payment as laid out by Jersey Athlete.