Date of Birth *
Street Address *
Zip Code *
Cell Phone *
The Consent/Waiver Statement must be agreed upon by the parent/guardian.
I, the Parent/Guardian of the registrant, a minor, hereby consent and allow the participation of the registrant in the Jersey South FC summer soccer camp. I agree that I the registrant will abide by the rules of the USSF, USYSA, NJ Youth Soccer, US Club Soccer and their affiliated organizations. I recognize the possibility of physical injury associated with soccer to the registrant and in consideration for Jersey South FC accepting the registrant for its try-outs and, I for myself and the registrant hereby release, discharge, indemnify and hold harmless the Jersey South, USSF, USYSA, NJ Youth Soccer, US Club Soccer, their affiliated organizations and sponsors, their employees and agents against any claim by or on behalf of myself or the registrant resulting from the registrant's participation in the tryouts. I further authorize any coach or trainer of Jersey South FC to seek medical treatment for the registrant in the event of an injury during the tryouts when I or another parent or guardian of the registrant is not present and cannot be promptly contacted to authorize such treatment. I accept full financial responsibility for any such necessary medical treatment.
I certify that I am the parent/guardian of the applicant and all of the information entered is accurate and correct.
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Today's Date *