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2019-2020 Season Tryout Registration
Use this form to register for a tryout opportunity.
Email address *
Parents Email Address *
Your answer
CHILD Last Name *
Your answer
CHILD First Name *
Your answer
CHILD Date of Birth (Ensure Birth Year is Correct, NOT 2019) *
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Gender *
Address (include City, State, Zip Code) *
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Parent Last Name *
Your answer
Parent First Name *
Your answer
Parent Phone Number *
Your answer
Emergency Contact (Name and Phone #) *
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Previous Soccer Experience (List Current Club Next the Other Check Box) *
Required
Have you ever been rendered unconscious or suffered a concussion? *
Required
Have you ever suffered a back injury? *
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? *
Required
List Known Allergies: *
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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: *
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Date *
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A copy of your responses will be emailed to the address you provided.
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