SOCCER Registration Form for 2017

Eden Jr. Athletic Association

SOCCER Registration Form for 2017

Cost: $40/Child Max: $120/Family

A $40.00 late fee will be added after July15th

Sign up ends July 31st, no exceptions

NOTE OF CONSENT:
Please fill out a separate note of consent for each child

Child’s Name: ______

Address: ______

Phone # to contact for practices: ______

Parent’s Names: ______cell#______

______cell#______

Email (print clearly): ______

School: ______

Gender: Male / Female Birth date: ______Age on Aug 1st: ______

# of Seasons Played: ______

List any special medical conditions that are of concern: ______
______
Shirt size: (circle one) Youth: S M L Adult: S M L XL XXL

In consideration of my child participating in an EJAA activity, I waive and release the EJAA, the Village of Eden, the Town of Eden, the members, coaches, and sponsors from responsibility for injuries which may occur during practicing, competing or traveling to and from activities. I also give my permission to administer medical aid in case of an emergency.

______

Signature of Parent or Guardian Date

I give permission for my child’s photo or image to be placed in a newspaper or on website.
______

Signature of parent or guardian Date

Working in the concession stand, or at ONE brat fry are only some places we need your help. Below is a list of other work, in which your help would be appreciated. If you can help, please put the name of the person that can help next to the item (s)he could help out with. Thank You!
Name Phone #

Referring (Min. Age: 11) ______certification level_____

Coach/Asst Coach; for the child on this form ______shirt size____

Team Sponsor: Contact Person: ______Phone #: ______Sponsor form can be found on the website

Facilities Maintenance and Preparation______

Soccer Committee ______
Mail to: EJAA, PO Box 322, Eden, WI 53019