Little Jewels Soccer Registration Form

Player's Name*

Last NameFirst Name

Male/Female*

Date of Birth of The Player*

Date

Parent/Guardian 1 Information*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

E-mail*

example@example.com

Parent/Guardian 2 Information*

First NameLast Name

Parent/ Guardian 2 email address*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Waiver & Assumption of Risk Waiver of Liability

In consideration of being permitted to participate in any way in a Jewel City United. activity, I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue Jewel City United, its officers, employees, and/or agents, as well as all facilities where the player and/or team trains and/or plays games, including the field facility owner or operator, their respective faculty, administration, and trustees, from liability for any and all claims, including the negligence of Jewel City United, its officers, employees, and/or agents, resulting in personal injury, accidents, illness (including death), and/or property loss arising from, but not limited to, participation in Jewel City United and activities.

Date*

Date

By entering my name in this box I agree to the terms of the waiver mentioned above. I further understand and agree that the foregoing Waiver & Assumption of Risk Waiver of Liability is intended to be enforceable to the fullest extent permitted by law. Please sign your name below:*

Assumption of Risk

Participation in Jewel City United activities carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from a) minor injuries such as scratches, bruises, and sprains to b) major injuries such as eye injuries or loss of sight, joint or back injuries, broken bones, heart attacks, and concussions, etc., to c) catastrophic injuries including paralysis and death.
I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in Jewel City United activities. I hereby assert that my participation is voluntary and that I knowingly assume all such risks. The undersigned further expressly agrees that the foregoing waiver and assumption of risks is intended to be as broad and inclusive as is permitted by the law of the State of California, and that if any portion thereof is found invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

By entering my name in this box I agree to the terms of the waiver mentioned above. I further understand and agree that the foregoing. Assumption of Risk Waiver of Liability is intended to be enforceable to the fullest extent permitted by law. Please sign your name below:*

RELEASE OF CLAIMS

As a condition of my child being permitted to participate in the Jewel City United Program, and for and in consideration of the services provided by Jewel City United and Jewel City United’s staff, I hereby waive and release any claims that I or we may have against Jewel City United, or their trustees, directors, officers, employees, volunteers, or agents based on any loss, illness or injury (including death) that my child may sustain arising from, in connection with, or incidental to my child’s participation, whether such loss, illness or injury is caused by my student’s own acts or omissions or by those of other program participants, Jewel City United staff or volunteers.

Signature*

My Products*

Soccer Training

Little Jewels Soccer Program Once a week training

$80.00

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

You will need to fill out one registration per child.

PLAYER INFORMATION:

PARENT/GUARDIAN INFORMATION:

Waiver & Assumption of Risk Waiver of Liability

Assumption of Risk

RELEASE OF CLAIMS