Last Updated: April 25, 2017
 Spring Travel Teams Players fees are due!  

2017 Spring Lacrosse

You must 1st register/Renew with US Lacrosse www.uslacrosse.org
A Youth membership is $25.00 annually.
* US Lacrosse No.:
* First Name:
* Last Name:
* Gender:
* Date of Birth:
CONTACT INFORMATION
* Contact Number:
* Address:
* Town:
* Zip Code:
Email Address:
Mother's Name:
Father's Name:
Release
• Registration fees are non-refundable. The Tarkill Board of Directors reserves the right to grant a refund in extreme cases of illness, injury, or hardship. A written request must be submitted for review by the board before any action will be considered.

• All injuries incurred while participating in a club activity must be reported to Tarkill Soccer Club immediately. Players requiring medical attention will be permitted to resume participation only upon presentation of a signed release from a physician.

• Medical Insurance is provided through affiliation with NJYSA. The coverage is secondary to your personal insurance. Tarkill Soccer club is not responsible for any deductible, co-payment, or other costs not covered by any insurance.

• You are registering your children with the understanding that Tarkill Soccer club will provide your children the opportunity to play soccer with our club and that there is no guarantee your child will be selected to a travel team.

• I authorize Tarkill soccer club to display my children's/ ward's pictures on Takill.com and Facebook. The only pictures that will be displayed will be taken from games, practices, and Tarkill Soccer Club related activities and events. Individual names will NEVER be listed with pictures.
I have read the above and understand all the terms and conditions. I agree to hold Tarkill Soccer Club and all Board of Directors, Coaches and players harmless from any and all claims arising from my child’s participation.   *
* Electronic Signature (Must be completed if not printing a blank form):

Signature: ___________________________________   Date: ____________________

* required


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Note: Credit Card information can be entered once this form is submitted