HSC’s Friday Night Lights, FREE 3v3 open play Tournament REGISTRATION

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Use this form to indicate interest in playing in the Hillsborough Soccer Club’s Friday Night Lights, FREE 3v3 Open Play Tournament each Friday night in Spring March 26th through June 4th. You will be notified of your acceptance.

Email *

Parents Email Address *

CHILD Last Name *

CHILD First Name *

CHILD Date of Birth (Ensure Birth Year is Correct, NOT 2019) *

YYYY

Gender *

Male

Female

Address (include City, State, Zip Code) *

Parent Last Name *

Parent First Name *

Parent Phone Number *

Emergency Contact (Name and Phone #) *

Previous Soccer Experience (List Current Club Next the Other Check Box) *

None

Recreation

HSC Travel

Other Club (Enter Club Name Below)

Other:

Required

Have you ever been rendered unconscious or suffered a concussion? *

Yes (please explain below)

Other:

Required

Have you ever suffered a back injury? *

Yes (please explain below)

Other:

Required

Have you ever been diagnosed, by a Doctor, with any serious medical conditions or any condition that may impact your ability to participate in athletic competitions? *

Yes (please explain below)

Other:

Required

List Known Allergies: *

Parent/Guardian Consent and Medical Release: Recognizing the possibility of injury or illness, and in consideration of NJ Youth Soccer and members of NJ Youth Soccer accepting my son/daughter/ward as a player in the soccer programs and activities of NJ Youth Soccer and its members (the "Programs"), I, freely and voluntarily and with full understanding of the consequences consent to my son/daughter/ward participating in the Programs. Further, I, on behalf of myself, my son/daughter/ward, and our heirs, executors and administrators, RELEASE,DISCHARGE AND OTHERWISE INDEMNIFY NJ Youth Soccer, its member organizations and sponsors, their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the Programs, from and against any claim by or on behalf of my player son/daughter/ward as a result of my son’s/daughter’s/ward’s participation in the Programs and/or being transported to or from the Programs, which transportation I hereby authorize, whether such claims are caused in whole or in part by the negligence, gross negligence or other act, omission or conduct on the part of NJ Youth Soccer or its members or otherwise. My player son/daughter/ward has received a physical examination from a physician and has been found physically capable of participating in the Programs. I have provided written notice, which was submitted in conjunction with this Release and attached hereto, setting forth any specific issue, condition, or ailment, in addition to what is specified in the NJ Youth Soccer Medical Release Form, that my child/ward has or that may impact my child's/ward’s participation in the Programs. I give my consent to have an athletic trainer and/or Doctor of Medicine or dentistry provide my child/ward with medical assistance and/or treatment during his/her participation in the Programs. I understand that I, my heirs, executors and administrators, will be responsible financially for the reasonable cost of such medical assistance and/or treatment my son/daughter/ward receives during participation in the Programs. Type Signature Below: *

Date *

YYYY

A copy of your responses will be emailed to the address you provided.

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