SJEB Rush Camp Registration Form
TEACHERS CONVENTION CAMP AT GLOUCESTER TWP COMMUNITY PARK
First Name
Last Name
Email 1
Email 2
Parent Cell 1
Parent Cell 2
DOB
MM
/
DD
/
YYYY
Gender
Clear selection
Home Town
Waiver & Medical Release
As parent/guardian of the above player, I certify that he/she is in excellent health and has no physical, mental or emotional problems that are likely to prevent participation in strenuous, physical play within the soccer program. I agree to hold harmless SJEB Rush, its agents, coaches, and employees and hereby release them from any liability on account of injuries sustained by the player while participating in the soccer program activities. I give permission for the player to be medically treated for illness occurring, or injury sustained, during such participation. I certify that the player is covered by medical insurance which will reimburse SJEB Rush for expenses incurred by them, their agents, coaches and employees on account of medical insurance ordered at their discretion and also to indemnify them for any expenses not reimbursed by such insurance. I give consent for the player to be photographed, videotaped and/or filmed while participating in the soccer program activities and for the resulting photos to be used by NJ Rush for educational and promotional purposes. NJ Rush are not responsible for any cancellations due to inclement weather.
Check the box to accept terms of the waiver & medical release
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