SJN Sports Registration Form

SJN Sports Registration Form
Student Name*

First NameLast Name
Age*
Grade*
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Name

First NameLast Name
Mother's Home Phone Number
Please enter a valid phone number.
Mother's Cell Phone Number
Please enter a valid phone number.
Mother's E-mail
example@example.com
Father's Name

First NameLast Name
Father's Home Number
Please enter a valid phone number.
Father's Cell Number
Please enter a valid phone number.
Father's Email
example@example.com
Sports*

Volleyball (Grades 4-8): $50Basketball (Grades 2-8): $50Soccer (Grades K-8): $50Track (Grades 1-8): $15
St. John Nepomuk Catholic School Release & Indemnification Agreement
The undersigned, being the parent and/or legal guardian of   Child's First and Last Name*   field in consideration of the agreement by St. John Nepomuk Catholic School to allow my child to participate in the sport(s) listed above, hereby agrees as follows:

1. That no claim will be made by the undersigned on behalf of myself or on behalf of my child for personal injuries or other losses sustained by my child as a result of my child’s participation in the above described sport(s).
2. That, in the event any claim is made by my child for injuries or damages sustained by my child as a result of my child’s participation in the above described sport(s), I shall hold St. John Nepomuk Catholic School harmless from, and indemnify it against, any such claim, including reasonable attorney’s fees incurred by   Child's First and Last Name* in connection therewith, whether or not such claims result in litigation.

The undersigned acknowledges that my child’s participation in the above described sport(s) may reasonably be considered a dangerous activity(ies). This Agreement is executed by the undersigned upon the understanding that St. John Nepomuk Catholic School will use best efforts in the conduct of the above described sport(s).
Signature*

Clear
****In the event of an emergency requiring medical attention, I authorize that necessary medical attention be given to my child by a qualified physician in the event I cannot be reached.
Signature*

Clear
Please list any allergies or difficulties that the staff should be aware of:
UNIFORMS*

I understand that all uniforms issued must be returned to the Athletic Commission clean and in satisfactory condition upon theconclusion of the season. If a uniform is not returned, then the Athletic Commission will bill me the replacement cost.
PARENTS: Please check if you would have an interest in helping with any of the

Coaching VolleyballCoaching BasketballCoaching SoccerCoaching TrackOther
After you submit the form, you will receive a separate email for payment through FACTS.

We look forward to a great year of sports.
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SJN Sports Registration Form

St. John Nepomuk Catholic School Release & Indemnification Agreement