Staten Island Futsal League - Sign Up Form
Every team coach, manager or director must complete this online form and submit the league entrée fee by November 25 in order to reserve a spot in the JCC of Staten Island FUTSAL League 2018-19.

Deposit of $100 must be paid within 48 Hours upon completion of this online form. The payment have to be made at the front desk of JCC located on 1466 Manor Road Staten Island NY 10314. All checks must be made out to JCC Soccer.

All Team Deposits and League Team Fee must be assigned to the program code: 19PE311W
All Payments Are Final - NO REFUNDS ALLOWED !

Any question or concerns please contact Ernest 347.612.0970 or emurdukhayev@sijcc.com

Coach Full Name *
Your answer
Email *
Your answer
Mobile Phone *
Your answer
Club / Team Name *
Your answer
Check the Age Group your team belongs to? *
Team Roster *
Please list up to 8 Players Full Names that will play in the league.
Your answer
Level of Competition *
Required
Gender *
Required
Chose a Payment Option *
Deposit of $100 must be paid with in 48 Hours of this registration date.
Required
Team and Player Liability Waiver *
JCC of Staten Island Liability Waiver IN CONSIDERATION OF being allowed to participate in any way in the JCC Futsal League related events and activities, undersigned acknowledges, appreciates, and agrees that: The risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 1) FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child's participation; and, 2) I willingly agree to comply with the program's stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child's readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and, 3)I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS JCC of Staten Island its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("Releases"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child's involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 4)I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releases from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, 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 INDUCEME
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