SJEB 2021 Summer Camp Registration
Player First *
Player Last *
Parent / Guardian *
Email 1 *
Email 2
Parent Cell 1
Parent Cell 2
DOB *
MM
/
DD
/
YYYY
Gender *
Current Club / Town *
I would like to register for the following camp(s); *
Required
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.

COMMUNICABLE DISEASE RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT
In consideration of being allowed to participate in any way in the program, related events and activities, I
the undersigned, acknowledge, appreciate, and agree that:
I am aware there are risks to me of exposure to directly or indirectly arising out of, contributed to, by, or
resulting from an outbreak of any and all communicable disease, including but not limited to, the virus
“severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”, which is responsible for Coronavirus
Disease (COVID-19) and/or any mutation or variation thereof.
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY
RELEASE, INDEMNIFY, AND HOLD HARMLESS NJ YOUTH SOCCER AND THE (NAME OF
ORGANIZATION), its officers, officials, agents and/or employees, other participants, sponsors,
advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES),
from any and all claims, demands, losses, and liability arising out of or related to any ILLNESS, INJURY,
DISABILITY OR DEATH I may suffer, WHETHER ARISING FROM THE NEGLIGENCE OF THE
RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY
SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Check the box to accept terms of the waiver/medical/COVID release *
Required
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