Jacksonville Area Soccer Association - AWS
Jacksonville A r e a Soccer Association Registration Spring
Last Name:
Middle I n i t i a l
F i r s t Name
Street
St
Citv
Zip Did
Form 2018
Telephone: (
)
he/she play F a l l 2017 ?: Yes
No
B i r t h C e r t i f i c a t e copy received?: C e l l Phone
(
B i r t h Date:
/
Male
/
Female
Another Club Email: D i v i s i o n : U-
)
#:
Team:
Father^s Name:
Occuoation:
Business Phone :
Mother-'s Name:
Occupation:
Business Phone :
( (
) )
V O L U N T E E R S N E E D E D ( P l e a s e Circle)
AUTHORIZATION T O P L A Y
Coach
I a u t h o r i z e m y c h i l d t o p l a y y o u t h soccei' w i t h t h e J a c k s o n v i l l e A r e a Soccer A s s o c i a t i o n ( J A S A ) . I , one o f the paients or guardians o f the above n a m e d candidate, do hereby give m y approval f o r m y child's participation i n any and a l l soccer activities. I do release, absolve, and h o l d harmless the Jacksonville A r e a Soccei' Association, and all otliers hsted hereafter; organizers, employees, officers, board m e m b e r s , c o a c h e s , r e f e i e e s , s p o n s o r s , s u p e r v i s o r s , a n d l a n d o w n e r s ( p e i m i t t i n g t h e use o f their land for soccer activities), any and a l l o f t h e m . I f m l h e r agree to abide by the rules, regulations and decisions o f J A S A , die J A S A E x e c u t i v e B o a r d , officers o r referees. I n case o f i n j u r y t o m y c h i l d I w a i v e a l l c l a i m s against organizers, sponsors or a n v supervisors a p p o i n t e d b y t h e m .
Asst. Coach
Field Preparation
T e a m Manager Concession Stand W o r k e r
J A S A is a n all-volunteer organization dedicated to p r o v i d i r ^ a n enjoyable and l e w a r d i n g s o c c e r e x p e r i e n c e t o c h i l d r e n a n d t h e i i " f a m i l i e s . J A S A j ' e c e i v e s no d i r e c t pubUc t u n d i n g a n d t h e success o f o u r p r o g r a m i s directly due t o the h a r d w o i k o f volunteers. T h e parent/guardian o f each J A S A player is expected to volunteer one h o u r per c h i l d , per season. Y o u r c o a c h o r t e a m m a n a g e r w i l l be c a l l i n g u p o n y o u t o d o y o u r "duty " Participation o f J A S A parents keeps our operational costs d o w n , r e g i s h a t i o n fees l o w , a n d i s a b e n e f i t t o a l l .
Parent/Guardian"s I u n d e r s t a n d that I w i l l b e c a l l e d \ i p o n t o assist w i t h m y c h i l d ' s soccer p r o g r a m
Parent/Guardian" s Signature
FOR
Date
OFFICIAL U S E ONLY
Plaver Fee: $ Date:
Signature
Fees (Please Circle):
R e c ' d By: Reaistration Number:
Age Division:
Assigned Team:
$50.00
Spark ( U 4 - U 6 )
$60.00
U7-U8
$70.00
Recreation (U9-U18)
T o t a l A m o u n t Enclosed: $ ( M a k e a l l checks p a y a b l e t o J A S A )
Emergency Information
P a g e 1 of 2
Fall 2015
Person to n o t i f y i n an emergency:
Contact Address:
Conect Phone Number:
Doctor to n o t i f y i n an emergency:
Doctor's phone number:
Insurance Company:
Insurance ID Number:
Name of Primary Insured Party: Date of l a s t Tetanus (mm/yyyy):
Medications now being taken:
Player i s a l l e r g i c to these medications and substances:
L i s t any unusual health information:
Page
2 of 2
Fall 2015
Last Name:
Middle I n i t i a l
F i r s t Name
Street
St
Citv
Zip Did
Form 2018
Telephone: (
)
he/she play F a l l 2017 ?: Yes
No
B i r t h C e r t i f i c a t e copy received?: C e l l Phone
(
B i r t h Date:
/
Male
/
Female
Another Club Email: D i v i s i o n : U-
)
#:
Team:
Father^s Name:
Occuoation:
Business Phone :
Mother-'s Name:
Occupation:
Business Phone :
( (
) )
V O L U N T E E R S N E E D E D ( P l e a s e Circle)
AUTHORIZATION T O P L A Y
Coach
I a u t h o r i z e m y c h i l d t o p l a y y o u t h soccei' w i t h t h e J a c k s o n v i l l e A r e a Soccer A s s o c i a t i o n ( J A S A ) . I , one o f the paients or guardians o f the above n a m e d candidate, do hereby give m y approval f o r m y child's participation i n any and a l l soccer activities. I do release, absolve, and h o l d harmless the Jacksonville A r e a Soccei' Association, and all otliers hsted hereafter; organizers, employees, officers, board m e m b e r s , c o a c h e s , r e f e i e e s , s p o n s o r s , s u p e r v i s o r s , a n d l a n d o w n e r s ( p e i m i t t i n g t h e use o f their land for soccer activities), any and a l l o f t h e m . I f m l h e r agree to abide by the rules, regulations and decisions o f J A S A , die J A S A E x e c u t i v e B o a r d , officers o r referees. I n case o f i n j u r y t o m y c h i l d I w a i v e a l l c l a i m s against organizers, sponsors or a n v supervisors a p p o i n t e d b y t h e m .
Asst. Coach
Field Preparation
T e a m Manager Concession Stand W o r k e r
J A S A is a n all-volunteer organization dedicated to p r o v i d i r ^ a n enjoyable and l e w a r d i n g s o c c e r e x p e r i e n c e t o c h i l d r e n a n d t h e i i " f a m i l i e s . J A S A j ' e c e i v e s no d i r e c t pubUc t u n d i n g a n d t h e success o f o u r p r o g r a m i s directly due t o the h a r d w o i k o f volunteers. T h e parent/guardian o f each J A S A player is expected to volunteer one h o u r per c h i l d , per season. Y o u r c o a c h o r t e a m m a n a g e r w i l l be c a l l i n g u p o n y o u t o d o y o u r "duty " Participation o f J A S A parents keeps our operational costs d o w n , r e g i s h a t i o n fees l o w , a n d i s a b e n e f i t t o a l l .
Parent/Guardian"s I u n d e r s t a n d that I w i l l b e c a l l e d \ i p o n t o assist w i t h m y c h i l d ' s soccer p r o g r a m
Parent/Guardian" s Signature
FOR
Date
OFFICIAL U S E ONLY
Plaver Fee: $ Date:
Signature
Fees (Please Circle):
R e c ' d By: Reaistration Number:
Age Division:
Assigned Team:
$50.00
Spark ( U 4 - U 6 )
$60.00
U7-U8
$70.00
Recreation (U9-U18)
T o t a l A m o u n t Enclosed: $ ( M a k e a l l checks p a y a b l e t o J A S A )
Emergency Information
P a g e 1 of 2
Fall 2015
Person to n o t i f y i n an emergency:
Contact Address:
Conect Phone Number:
Doctor to n o t i f y i n an emergency:
Doctor's phone number:
Insurance Company:
Insurance ID Number:
Name of Primary Insured Party: Date of l a s t Tetanus (mm/yyyy):
Medications now being taken:
Player i s a l l e r g i c to these medications and substances:
L i s t any unusual health information:
Page
2 of 2
Fall 2015
