Test

Choose One*

Player Name*

Date of Birth*

Age*

Mother's Name*

Father's Name*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone*

Email*

Enter Email Confirm Email

Emergency Name and Phone*

Confirm Academy Location*

Confirm Day and Time*

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Yes
No

Please describe the condition

Is the athlete prescribed an inhaler? If yes, please explain any instructions.*

Yes
No

Please explain any instructions

Photo consent*

I hereby grant and authorize John Tomlinson Soccer LLC to make use of photos involving my child
I do not grant and authorize John Tomlinson Soccer LLC to make use of photos involving my child.

We, at John Tomlinson soccer LLC, may take photos of your child during their participation in John Tomlinson Soccer Programming. In this regard, we seek your consent for the publishing or use of photos which your child may be included. The photos will be used for marketing and/or advertising, posted on social media platforms such facebook/Instagram /Twitter and the John Tomlinson Soccer website.

Informed Consent and Acknowledgement
I hereby give my approval for my child’s participation in any and all activities prepared by during the selected camp. In exchange for the acceptance of said child’s candidacy by John Tomlinson Soccer LLC , I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless John Tomlinson Soccer LLC and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against. including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including soccer. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization
As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.
Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.
Permission is also granted to John Tomlinson Soccer LLC and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.
Release authorized on the dates and/or duration of the registered season.
This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Total

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Winter Indoor Soccer Registration