Printable Registration Page
Registration Page

 

 

Either print out this page and complete and mail to USA or complete the form on your computer and print out when complete. Completed forms may either be faxed to (732) 563-2537 or mailed to: United Soccer Academy, 12 Maiden Lane - Suite 1, Bound Brook , NJ 08805
   
  Family Details
  Family Name
  Street Address
  City
  State

 

  
  Zip
  Home Phone
  Daytime Phone
  Emergency Phone
  E-Mail
   
  Player 1
  Name
  Camp/Class Location
  Camp/Class Site
  Camp/Class Times
  Team Name (If applicable)
  Camp/Class Code E.g. JS001
  Date of Birth Month Day Year
  Age
  Gender
   
  Player 2   If applicable
  Name
  Camp/Class Location
  Camp/Class Site
  Camp/Class Times
  Team Name (If applicable)
  Camp/Class Code E.g. JS001
  Date of Birth Month Day Year
  Age
  Gender
   
  Payment & Registration Information
  Registration 1
  Registration 2  
  Total Fee Due
   
  Card Type
  Name on Card
  Card Number
  Expiry Date Month      Year 
   

I hereby agree to let my child participate in the sporting activities on this camp or program. I understand that there are certain risks of injury inherent in the practice and play of these sports, as well as in traveling and other related activities incidental to my participation, and am willing to assume these risks. I hereby certify that my child is fully capable of participating in these sports and that he/she is healthy and has no physical or mental disabilities or infirmities that would that would restrict full participation in this activity, except as included in writing with this application. In addition to giving full consent for my child's participation, I do hereby waive, release and hold harmless United Soccer Academy, inc., its officers, coaches, sponsors, supervisors and representatives for any injury that may be suffered by my child in the normal course of participation in these sports and the activities incidental thereto, whether the result of negligence or any other cause. I grant permission for my child to receive emergency medical treatment. I grant United Soccer Academy, Inc., permission to use photographic or video images of my child in future promotional materials.

1.  Players should bring a soccer ball, snacks and water to class. It is recommended that shin guards, soccer shoes or sneakers be worn.
2.  Merchandise may be sold on programs.
3.  Your cancelled check is confirmation that your place is confirmed. If you require additional confirmation of enrollment please include a stamped, S.A.E. 
4.  Refunds will not be issued in the event of non-participation. Administration fee of $50 will be charged for all cancelled registrations where a refund  is requested. A credit voucher for the full registration fee is available in place of a refund. 
5.  No refunds or credits will be issued once a program or camp has started. 
6.  If a portion of the class is cancelled by USA due to adverse weather conditions and the time is unable to be made up then a pro rated credit voucher will be issued. Cash refunds will not be issued in the case of weather cancellations.  In the event of inclement weather please call the Rain-out line at (732) 563-2538 - Do not call the main office for rain-out information.

I have read the above release and I agree that by printing ‘YES‘ in the box below that I accept all terms & conditions as stated. I also attest that I am a legal guardian of the children which I am registering. I also approve my credit card to be charged for the amount indicated in the 'Total Fee Due' Box unless I have mailed in a check for payment.
   

  If you do not enter 'yes' in this box then your order cannot be processed.