INDIVIDUAL REGISTRATION/ WAIVER FORM

Must be completed by all participants

 JESA 5 v 5 TOURNAMENT

Del Mar High School

Name of Player:__________________________________________________________

Date of Birth:_________________PreviousExperience:_________________________

Parent/Guardian:__________________________________________________

Address:________________________________________________________

City:______________________, CA    Zipcode:_________________________

Day Phone:__________________Evening Phone:_______________________

E-mail address:_______________Emergency Contact Number:___________

Do you have health/group medical insurance to cover said minor?________

Do you know of any physical impairment that would be effected by participation in a soccer Tournament session?_________________________________________

Parental Consent and Waiver  

I, as parent/guardian, hereby give my permission for said player to participate in the JESA 5 v 5 Tournament sessions and agree to release, indemnify, and hold harmless the organizers and volunteers of these sessions from any and all claims arising out of injury to the above said minor.
I have no knowledge of any physical impairment that would be effected by the above named minor¹s participation in these sessions.
I acknowledge that soccer activities are of a strenuous physical nature that does pose some inherent risk to injury.
I hereby authorize the organizers/volunteers of these sessions to act for me according to their best judgment in any emergency requiring medical/dental attention. JESA will not provide health and/or accident insurance for participants.   My signature on this waiver also states that the above named player is covered by my personal medical insurance policy.  I understand that I will be financially responsible for all charges and fees incurred in the rendering of said treatment, regardless of whether my medical insurance would cover such charges and fees.
I agree that pictures taken during training sessions may be used for future promotional purposes.
I have read, understood and approve the above waiver.

_____________________________________           _______________________
Signature                                                                                      Date

Tom 408-872-3134 tmorman@comcast.net

Jorge 408-203-5262 jesasoccer@yahoo.com

JESA – P O Box 92 -  Campbell, CA 95009

http://www.jesasoccer.net

Team Registration Form

5 v 5  OUTDOOR TOURNAMENT

Must be accompanied by waiver forms for each player

Team name………………………………………….

Age Group…………………………………………..

Gender………………………………………………

Contact Person………………………………….…..

Contact e-mail………………………………………

Address………………………………………….…..

Phone Number……………Cell Number….………

Roster

       First                         Last                            Birthdate            

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Tom 408-872-3134  tmorman@comcast.net

Jorge 408-203-5262 jesasoccer@yahoo.com

Teddy 650-796-7830 teddy369@comcast.net

JESA – P O Box 92 - Campbell CA 95009

http://www.jesasoccer.net