Registration Form

US Premier Soccer

To Register:

Mail this Registration Form and Payment to:

US Premier Soccer, 16 Doreen Drive, Oceanport, NJ 07757

                                                 or

Fax this Application with your Credit Card information to 732-571-2881
Team Club  Team Name
 Age  Contact Name
 Sex  Contact Street Address
Apt #  Contact Town
 State  Contact Zip
 Contact First Name  Contact Last Name
E-Mail Address  Home Telephone
Work Telephone Cell Telephone
 League Code  League Fee
 
  Payment Type Credit Card Number
Signature Expiration Date

I hereby agree to allow my team to participate in the sport of soccer. I understand there are certain risks of injury inherent in the practice and play of this sport as well as traveling and other related activities incidental to my participation and I am willing to assume these risks. I herby certify that my team is fully capable of participating in the sport of soccer and they are healthy and have no physical or mental disabilities or infirmities that would restrict full participation in this activity. In addition, to giving my full consent for my child’s participation, I do herby waive, release, and hold harmless USP Soccer, Ocean Sports Academy, it’s officers, coaches, sponsors, supervisors, and representatives for any injury that may be suffered by my child in the normal course of participation in the sport of soccer and the activities incidental thereto, whether the result of negligence or any other cause. I grant permission for my child to receive emergency medical treatment from trained emergency medical professionals. I understand that the staff will not perform any invasive procedures of any kind nor be responsible for the disbursement of medications. I grant, USP Soccer. permission to use photographic or video images in future promotional materials.
Contact Signature______________________________________ Date_______________
 (PLEASE INCLUDE A COPY OF YOUR ROSTER WITH THIS APPLICATION)