J2 Soccer Application 2015

(805) 889-6776
J2CamarilloSoccer@gmail.com
Last Name____________________

First Name_______________________

( )M ( )F Age_________ Date of Birth__________________________________

Address_________________________________________________________
City________________________________ St.____

Zip_______________

Mothers Name_________________________ Cell________________________

Fathers Name_________________________ Cell________________________
Email Address___________________________________________________
Medical Ins.Company____________________Policy #____________________
Allergies_________________________ Medical Conditions________________
Emergency Contact: (other than parent)_________________________
Phone number_______________________

Season
( ) Spring
( ) Summer

Dates
April 10 May 29
June 12 July 31

Price
$ 88
$ 88

WAIVER AND RELEASE OF LIABILITY

Notice to Parent or Guardian: Do not sign this agreement before you read it.
I acknowledge that my child will not be permitted to attend J2 Soccer if I do
not agree to the terms of this waiver.
I would like my child/children to attend J2 Soccer. I acknowledge that playing
at the J2 Soccer location and participation in activities there can be
INHERENTLY DANGEROUS ACTIVITIES which involve risk of injury. I
acknowledge that my child may sustain injuries. On behalf of my child, I
EXPRESSLY ASSUME ALL KNOWN OR UNKNOWN RISKS involved in such
activities and ALLOW MY CHILD TO PARTICIPATE. I acknowledge that due to
the nature of playing soccer that accidents can and do occur even if the
utmost care and safety is exercised. Nevertheless, I hereby EXPRESSLY
WAIVE, RELEASE, AND FOREVER DISCHARGE the J2 Soccer coaches, the
owners of J2 Soccer, Instructors, Employees, Sponsors and affiliates
whosoever from ANY AND ALL LIABILITY, CLAIM, LOSS, DAMAGE, COST, OR
EXPENSE arising from, or attributable in any way to, ANY NEGLIGENT ACT
OR OMISSION on the part of any such person or J2 Soccer I acknowledge
that I have carefully read this waiver and release and FULLY UNDERSTAND
that it is a RELEASE OF LIABILITY. I also acknowledge that I AM WAIVING
ANY AND ALL RIGHTS that I may have to bring a lawsuit in which I could
assert a claim on behalf of my child against J2 Soccer and all the other
persons mentioned above for ANY INJURIES OR DAMAGES CAUSED BY THE
NEGLIGENCE OF THE AFOREMENTIONED PARTIES.

_______________________________________________
Signature

Date