New Jersey Youth Soccer Player Membership Form printable pdf download

New Jersey Youth Soccer

PLAYER MEMBERSHIP FORM

(Type or Print Legibly)

First Name: _________________________

Last Name: __________________________________

Address: ___________________________________________________________________________

Town: ___________________________________ State: _________

Zip: _________________

Telephone:

(_______)_____________________________

Date of Birth:______________________________ Age: U- ______

Male: ____ Female: ____

[Month/Day/Year]

League:_________________________________________________

League # ________________

Club: __________________________________________________

Club # __________________

Team Name: ______________________________

Pass # _________________________________

IMPORTANT

I, the parent/guardian of the above named player, a minor, agree that I and the player will abide by the

rules and regulations of US Soccer, US Youth Soccer its affiliated organizations including New Jersey

Youth Soccer and it sponsors. In consideration of the player’s participation in the soccer programs

intending to be legally bound, we hereby release and indemnify US Soccer, US Youth Soccer, New

Jersey Youth Soccer, the owners and operators of the facilities used for the Programs and their respective

directors, officers, employees, agents and representatives from and against all claims, liabilities, damages

or causes of action arising out of or in connection with the player’s participation in the Programs

including, without limitation, player’s transportation to/from any Program, which transportation is hereby

authorized. I further grant US Soccer, US Youth Soccer, New Jersey Youth Soccer and their sponsors

the right to use the player’s name, picture and/or likeness in printed, broadcast and other material

concerning the Programs provided such use is related to the player’s status as a participant in the

Programs.

Name: ____________________________ Player: _____________________________

Print Name of Parent/Guardian

Print Player Name

Signature: ________________________ Signature: __________________________

Signature of Parent/Legal Guardian

Signature of Player

Date: ___________________________

Date: _______________________________

New Jersey Youth Soccer Player Membership Form