JUSC 2018-19 Competitive Soccer Tryout Registration
Thank you for your interest in Jupiter United Soccer Club. Please fill out the registration information below and and if you have any questions please contact Steve Casper at Jupiterunitedfc@gmail.com. Tryout dates and times will be emailed to all tryout registrants and will be posted on social media.
Player's Last Name *
Your answer
Player's First Name *
Your answer
What is player's birth year?
What is player's birth month? *
What is player's birth day? *
Player's Gender *
Player's Address *
Your answer
Player's Address (2)
Your answer
Player's City/Town *
Your answer
Parent 1 Last Name *
Your answer
Parent 1 First Name *
Your answer
Parent 1 Email *
Your answer
Parent 1 Email - Please re-enter for verification *
Your answer
Parent 1 Cell Phone *
Your answer
Parent 2 Last Name
Your answer
Parent 2 First Name
Your answer
Parent 2 Email
Your answer
Parent 2 Email - Please re-enter for verification
Your answer
Parent 2 Cell Phone
Your answer
Current Club *
Known Allergies or Medical Conditions? *
Please provide allergy/medical information:
Your answer
RELEASE OF LEGAL GUARDIAN ON BEHALF OF A MINOR as a parent/guardian of the applicant, I understand that electronic submission of this form means I hereby give my permission for my child to participate in the program/camp mentioned above, and agree to comply with all program regulations. I hereby remove the campsite, staff, and management of local organization and from any liability for injuries incurred during my child's participation in this program. I, the undersigned parent/guardian, do hereby authorize the athletic trainer or coaches at the program/camp or local organization to secure any and all medical treatment in the event that I cannot be contacted. I further authorize any attending physician to render any and all medical care he/she may deem necessary. During your child’s participation in one of our soccer programs, from time to time we may wish to take photographs or video of activities that involve your child. The photographs/video may be used for purposes of recording activities, for displays, publications or on a website by us, by local newspapers or occasionally by national agencies. Before taking any photographs or video of your child, we need your permission. By placing a check in the box below you give your permission for us to take your child’s photograph or video. If you do not wish your child to be photographed please email us and we will refrain from taking any photographs or video that include your child. Please note: If you wish to take photographs of your own and other children at our events or functions, please take appropriate images, be sensitive to other people and try not to interrupt or disrupt the coaches whilst working. Thank you *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms