Sports Eiland Soccer Program Registration Form

Sports Eiland Soccer Program Registration Form
Pick one:

Soccer
Gender:

MaleFemale
Age Level:

4U6U8U10U12U
Child's Name

First NameLast Name
Child's D.O.B

MonthDayYear
Age:
Parent's Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Medical Information

Allergies/ Medical Conditions

Medications
Emergency Contact Name

First NameLast Name
Emergency Contact Number
Please enter a valid phone number.
Waiver and Release of Liability

In Consideration of my/our child being allowed to participate in any way for Sports Eiland LLC. Soccer Program for the 2025/2026 season, it's related events and activities, the undersigned acknowledges, appreciates, and agrees that:

Waiver and Release of Liability:

I, the undersigned, hereby acknowledge and agree that participation in the Sports Eiland LLC. soccer program involves inherent risks, including but not limited to the risk of injury. I voluntarily assume all risks associated with participation in the program.

I hereby release and hold harmless Sports Eiland LLC, its officers, agents, and employees from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury that may be sustained by the participant, whether caused by negligence or otherwise.

Consent for Medical Treatment:

In the event of an emergency, I hereby authorize the program staff to obtain medical treatment for the participant. I understand that I will be responsible for any medical expenses incurred.

Acknowledgment of Understanding:

I have read this waiver of liability, fully understand its terms, and sign it freely and voluntarily without any inducement.
Powered by Jotform SignClear
Signature
My Products
prevnext( X )
Soccer RegistrationAll Ages payment per month Please Pay by Zelle to sportseiland@gmail.com Or by check to Sports Eiland LLC.
$75.00 Quantity
Should be Empty: