Registration Form

ATHLETES NAME (First, Last) *as it appears on birth certificate

AGE as of August 1st?

Date of Birth

MEDICAL RELEASE PARENT OR LEGAL GUARDIAN’S AUTHORIZATION

In case of Emergency, if the family physician cannot be reached, I hereby authorize my child, to be treated by another qualified, licensed physician who is available at the time and I am responsible for all costs associated with the treatment of my child.

Physician's Name

ATHLETES NAME (First, Last) *as it appears on birth certificate (Child 2)

AGE as of August 1st (Child 2)?

Date of Birth (Child 2)

Physician's Name (Child 2)

Child 2

ATHLETES NAME (First, Last) *as it appears on birth certificate (Child 3)

AGE as of August 1st (Child 3)?

Date of Birth (Child 3)

Physician's Name (Child 3)

Child 3

ATHLETES NAME (First, Last) *as it appears on birth certificate (Child 4)

AGE as of August 1st (Child 4)?

Date of Birth (Child 4)

Physician's Name (Child 4)

Child 4

ATHLETES NAME (First, Last) *as it appears on birth certificate (Child 5)

AGE as of August 1st (Child 5)?

Date of Birth (Child 5)

Physician's Name (Child 5)

Child 5

Our Policies

Please click here to view and read all of our policies. Once you have read and understand the policies, sign below.

I fully understand and will abide to the fundraising requirements & all policies.

I have read, understand, and agree;

to all sections of this document and agree to adhere to all conditions contained within. I also agree to abide by all rules, regulations, and Bylaws of the Judson Jr. Rockets Organization. I understand that these are available at my request. I understand that all coaches, administrators, and committee members are not professionals, but are volunteers, and may not be specifically trained for the task they are performing.

I certify that I am the legal Parent/Guardian of the participant named above and that I agree to let my child participate in the JJR organization and will uphold the JJR rules and Bylaws. Further, I agree to forever hold harmless the Judson Jr. Rockets Organization for any damage or injury received while participating in or while attending JJR events.

By signing below, I confirm that all information herein contained is true and correct to the best of my knowledge.

Your Signature

First Name

Last Name

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

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