Clinic Registration



REGISTRATION CLOSES ON 10/20/2019


For more information on the Clinic, visit the Clinic home page.

SJSA Clinic Registration

  I have read and will abide by the St. John's Sports Association's Code of Conduct.


 

Parent/Guardian Information

First Name   Last Name 

Street Address 

City         State       Zip code  

Phone number     Email 


 

Emergency Contact Information

First Name   Last Name 

Phone number     Email 


 

Registrant Information

First Name     Last Name 

Sex       Grade       Date of Birth     Shirt size 

School

 

Medical Conditions / Notes :    

 

Waiver & Release

  As the parent/guardian of the child named above, who will be participating in the St. John's Sports Association (hereinafter “SJSA”), I hereby grant permission for my child to participate in any and all activities of the SJSA during the upcoming season. I assume all risks and hazards to my child incidental to the conduct of the SJSA activities. I do further hereby release, absolve, indemnify, and hold harmless the SJSA (including without limitation, its Executive Board, Trustees, Managers, Coaches, and others acting under its authority) from and against any and all claims arising in any way from my child’s participation in the activities of the SJSA.

I hereby certify that my child has undergone a physical examination performed by a physician within the past year and has been cleared by said physician to participate in practices, games and related SJSA activities. My child is in good health and able to participate in the SJSA program. All physical and/or medical conditions or limitations requiring mediation and/or treatment are listed on the registration form above. Should my child become injured, ill or incapacitated while participating in the activities of the SJSA, I grant the SJSA and its Coaches and other authorized officials full authority to take whatever action is deemed necessary regarding my child’s health, safety and well-being, including arranging and/or providing emergency or other medical treatment.

I hereby certify and confirm that I have valid and current medical insurance coverage for any injury, medical condition, emergency, or other medical examination, testing or treatment that may arise as a result of my child’s participation in SJSA activities. I further understand and acknowledge that any insurance coverage maintained by the SJSA is secondary, supplemental and excess coverage to my own medical insurance coverage for my child, and that such secondary, supplemental, or excess coverage is subject to applicable exclusions, restrictions, limitations, deductibles, co-payments and other terms and conditions of such insurance policies, and may not cover all medical bills in full. I also specifically understand and agree that I am personally responsible to pay any and all medical bills or other out-of-pocket costs associated with any injury, medical condition, emergency or other medical treatment arising from my child’s participation in SJSA activities. I hereby release and hold harmless the SJSA and its Executive Board, Trustees, Coaches and other agents from any claims or liability for decisions or actions that may be taken on my child’s behalf (including, without limitation, transportation to a medical facility in my absence), for any emergency care rendered by authorized SJSA officials, for any expenses incurred as a result thereof, and from any and all other claims or actions which may arise out of my child’s participation in SJSA activities.

Photo/Video Release

 hereby grant permission for St. John's Sports Association to use pictures of my son/daughter (named above) for the express purpose of promotion of St. John's Sports Association programs and to post pictures/videos of my son/daughter, on the St. John's Association website.

 

 



The St. Johns Sports Association is currently

looking for coaches and program volunteers.

If you are interested, please visit the Volunteering page.



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