BOX2BOX Soccer :: Registration Form

Program Registration Form

Player Name:

Program:

Player Age:

Parent Pickup: Yes No

Medical Issues?:

Parent Emergency Telephone #: ()

E-mail Address:

Permission to Engage in Athletic Activities:
Soccer is a participation sport where injuries may frequently occur, By signing this agreement it is understood that BOX2BOX Soccer LLC can in no way be held responsible for injury liability to players. I grant permission for my child to receive emergency medical treatment. In case of inclement weather, lost time will be made up at a later date or a credit voucher will be issued. Players are required to bring shin guards, snack and a water bottle.

Signature of Parent or Guadian

Date

Remittance Instructions:
Make checks payable to BOX2BOX Soccer, LLC.

then send completed and signed form, with payment, to:

Box2Box Soccer, LLC
718 Union Avenue, #283
Middlesex, NJ 08846

Payment must be received prior to the first day of program or add $15 to program price. Each Participant MUST bring a copy of Mandatory health information regarding immunization and health history. This is required for program registration and participation. Each BOX2BOX Soccer Trainer is fully licensed and insured.

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