Club Registration Form

                                  Jersey Knights Soccer Club 
                                     Club Registration Form

Name: ____________________ Birth Date: __________Gender:   Boy      Girl

Address: _______________________________________________________________

Town/Zip :______________________________________________________________

* E Mail: ________________________________ Phone (H): _____________________ 

Phone (W): ____________________

Phone (C): _____________________

Mothers Name:____________________

Fathers Name: ____________________

Current Team & Flight: __________________________________________________

Required Medical Release:

Participation in any sport may cause physical injury, sprains, strains, etc. We, the undersigned, understand soccer is a contact sport and do not hold the Jersey Knights, its representatives, and employees responsible for injuries occurring during the course of the tryout process.

Date: __________ Signature: ____________________