|
Registration
Form
|
USP
Soccer / NJ
Wildcats |
Summer
2010 Select Tryouts |
|
|
|
|
|
Tryout Date - 4/10
|
|
|
Times - 2pm to 3:30pm - Boys, 3:30pm to 5pm - Girls
|
|
|
Location - Conover Park, West Windsor, NJ
|
|
|
(Directions
to Conover Park in West Windsor, NJ - CLICK HERE)
|
|
|
|
|
|
To Register:
|
|
|
Mail this
Registration Form to:
|
|
|
USP Select / NJ Wildcats Select, 16 Doreen Drive, Oceanport, NJ
07757
|
|
|
or
|
|
|
Fax this Application to 732-571-2881
|
|
|
|
|
|
|
|
|
Players
First
Name |
|
|
|
Players
Last Name |
|
|
|
|
Age |
|
|
|
Date of Birth |
|
|
|
|
Sex |
|
|
|
Street Address |
|
|
|
|
Apt # |
|
|
|
Town |
|
|
|
|
State |
|
|
|
Zip |
|
|
|
|
|
|
|
|
|
|
|
|
|
Parents
First Name |
|
|
|
Parents
Last Name |
|
|
|
|
E-Mail Address |
|
|
|
Home
Phone |
|
|
|
|
Work Phone |
|
|
|
Cell
Phone |
|
|
|
|
Special Medical Information |
|
|
|
|
|
|
|
|
Insurance Company |
|
|
|
Insurance Card Number |
|
|
|
|
|
|
|
|
|
|
|
|
|
I hereby agree to allow my child to participate in the
sport of soccer. I understand there are certain risks of injury inherent
in the practice and play of this sport as well as traveling and other
related activities incidental to my participation and I am willing to
assume these risks. I herby certify that my child is fully capable of
participating in the sport of soccer and he/she is healthy and has no
physical or mental disabilities or infirmities that would restrict full
participation in this activity. In addition, to giving my full consent for
my child’s participation, I do herby waive, release, and hold harmless
NJ Wildcats, USP Soccer, WWP SA, Township of West Windsor, Kevin
McDermott, their officers, coaches, sponsors, supervisors, and
representatives for any injury that may be
suffered by my child in the normal course of participation in the sport of
soccer and the activities incidental thereto, whether the result of
negligence or any other cause. I grant permission for my child to receive
emergency medical treatment from trained emergency medical professionals.
I understand that the staff will not perform any invasive procedures of
any kind nor be responsible for the disbursement of medications. I grant permission to use photographic or video images in future
promotional materials. |
|
|
|
|
|
Legal Guardian
Signature______________________________________ Date_______________ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|