Parent Name
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First Name
Last Name
Phone
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Email
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Parent Name
First Name
Last Name
Phone
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Email
Home Address
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Emergency contact (other than parents)
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First Name
Last Name
Emergency contact (other than parents)
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(###)
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Child's Name
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First Name
Last Name
Gender
Child's Date of Birth
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MM
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Allergies and/or special concerns
T-shirt size
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Youth T-Shirt sizes
Fall 2021 options (Weekends)
*For a customized schedule, please contact Coach Walter at 714-269-0230
Payment options
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Payment required upon completion of registration form to secure placement.
Group sessions are limited to 8 footballers on a first come first served basis.
Release and Waiver of Liability
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By selecting agree below submitting this online form by hitting the “SUBMIT” button below, which constitutes my electronic signature, I acknowledge and agree as follows:
1. I permit my child to fully participate in the voluntary activities sponsored by Joük, LLC (the “Program” or “Joük”).
2. I acknowledge, agree and represent that I understand the nature of the activity and that my child is qualified, in good health and in proper physical condition to participate in such activity. I further agree and warrant that if at any time I believe conditions to be unsafe for my child to participate, I will immediately discontinue my child’s further participation in the activity.
3. I FULLY UNDERSTAND that: (a) ATHLETIC ACTIVITIES INVOLVE RISKS & DANGERS OF SERIOUS INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, & DEATH (“RISKS”); (b) these Risks may be reduced by particular rules, equipment, & personal discipline, however the risk of serious injury does still exist; (c) these Risks & dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the activity, the condition in which the activity takes place, or THE NEGLIGENCE OF THE “RELEASES” NAMED BELOW; (d) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSES either not known to me or not readily foreseeable at this time, and I KNOWINGLY, FREELY, AND FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSES, COSTS, AND DAMAGES my child incur as a result of his or her participation in the activity.
4. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my child’s presence or participation, I will remove my child from participation and bring such to the attention of the nearest official immediately.
5. I, for myself and on behalf of my participating heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Joük, their officers, members, managers, officials, agents, and/or employees, coaches, directors, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the events (“RELEASES), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, to the fullest extent permitted by law.
6. I certify that I, as parent/guardian with legal responsibility for the minor participant, do consent & agree to his/her release as provided above of all the releasees, and for myself, my heirs, and next of kin, I release & agree to indemnity and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.
7. I grant to the directors, assistant or assigned coaches of Joük to act as guardians/spokesman in granting permission for emergency treatment/hospitalization (including anesthesia) if necessary for my child enroute to or from the Program site, hospital or other medical facility. I understand that should a health emergency arise, I will be attempted to be notified but that if I cannot be reached by telephone, such medical treatment deemed necessary, by competent medical personnel is authorized.
I hereby authorize, Joük to allow the reproduction, dissemination, and/or publication of my name and likeness for media coverage, public relations, or any other purpose which may involve the use of photographs, films, and/or video tape recording. This is to be done in conjunction with my participating in the Program, and I understand and agree that I may neither pay a fee to receive individual promotional consideration from my participation in this program, nor will I receive payment for the possible commercial use of my name or likeness.
Agree
Electronic Signature Date
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MM
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YYYY
Welcome to Joük!
Now in New York City your child will have access to a technical development program that focuses on three (3) core fundamentals: ball mastery, body control and functional practices.
Get ready to elevate your child’s soccer skills to the next level.
Please make sure to arrive 5-15 minutes early for processing.
Thanks in advance and see you soon.
Walter Altamirano
jouksoccer@gmail.com
714.269.0230
“Joük your way through life.”
