Community Soccer / Basketball Registration (JosiahKids)

Soccer / Basketball Registration

Community Application
This form is to be used to register for JosiahKids' Community Soccer, Basketball or both. The application may be used to register up to five students, as long as all students being registered on the same form share the same parent or legal guardian.
PLAYER INFORMATION:
PLAYER (1) - Full Legal Name *

First Name Last Name
Birth Date *

Month Day Year
Gender *
PLAYER (2) - Full Legal Name

First Name Last Name
Birth Date

Month Day Year
Gender
PLAYER (3) - Full Legal Name

First Name Last Name
Birth Date

Month Day Year
Gender
PLAYER (4) - Full Legal Name

First Name Last Name
Birth Date

Month Day Year
Gender
PLAYER (5) - Full Legal Name

First Name Last Name
Birth Date

Month Day Year
Gender
PARENT/GUARDIAN INFORMATION:
Full Legal Name *

First Name Last Name
Cell Phone Number *

Area Code Phone Number
E-mail Address *
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Emergency Contact / Full Legal Name *

First Name Last Name
Emergency Contact / Phone Number *

Area Code Phone Number
Emergency Contact / E-mail Address *
example@example.com
PREVIOUS PLAYING EXPERIENCE
PREVIOUS EXPERIENCE/TEAMS
No experience is necessary, but we do like to know what previous experience your child/children have playing soccer/basketball, please.
MEDICAL INFORMATION
Physician's Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Medical Conditions, Restrictions and Or Any Known Allergies *
Every student must have a physical with medical clearance from a physician prior to beginning any sports activity with JosiahKids.
Waiver Acknowledgement

*A separate waiver will be required
IMPORTANT: JosiahKids Incorporated requires a signed waiver to be completed for each family at the start of every school year prior to participating in any of our activities. The electronic waiver can be found on our website at: https://www.josiahkids.com/waivers
Date

Month Day Year
Parent / Legal Guardian's Signature

Clear
By submitting the form, I, as the registrant, hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may given under whatever conditions are necessary to preserve the life, limb, or well-being of registrant.

By submitting the form, I, the registrant, agree that I will abide by the rules of JosiahKids Incorporated, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and basketball and in consideration for JosiahKids Inc., accepting for its soccer programs and activities (the "Programs"). I hereby release, discharge and/or otherwise indemnify JosiahKids Inc. its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claimby as a result of my participation in the Programs. I hereby authorize and agree to the above.
REGISTRATION PAYMENT

Payments made to JosiahKids Incorporated are applied towards the sports equipment we use, as well as the insurance and rental of the facilities we use. A $30 non-refundable fee (per family) will be retained for all cancellations received on or after the first day of class. No refunds of any amount will be issued following the 2nd class. All cancellations must be submitted to the Athletics Director's attention at: contactus@josiahkids.com

The following prices apply to all the soccer and basketball classes we will offer during the school year. A detailed schedule is available on our website (www.josiahkids.com). Soccer will be offered from 2-3 pm and Basketball from 3-4 pm. The cost for families with 3 or more children is the same. In case of bad weather, Soccer may be cancelled if no indoor alternative can be found. *

SOCCER + BASKETBALL = 1 Child $ 60.00

SOCCER + BASKETBALL = 2 Children $ 80.00

SOCCER + BASKETBALL = 3 or More Children $ 100.00

SOCCER = 1 Child $ 40.00

SOCCER - 2 Children $ 60.00

SOCCER - 3 or More Children $ 80.00

BASKETBALL - 1 Child $ 40.00

BASKETBALL - 2 Children $ 60.00

BASKETBALL - 3 or More Children $ 80.00

SPORTS - Will Pay In Person Free

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Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00

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Soccer / Basketball Registration

PLAYER INFORMATION:

PARENT/GUARDIAN INFORMATION:

PREVIOUS PLAYING EXPERIENCE

MEDICAL INFORMATION

Waiver Acknowledgement

REGISTRATION PAYMENT

Credit Card