DOB	Age	Gender
		Male Female
Height	Weight

Soccer League Registration Fees
(tax included in price)

FOR TEAM REGISTRATION CLICK HERE

Payment Information
Registering For:	Please Chose One Summer Youth Soccer League (through Age 11).... $90 Summer Junior Soccer (Ages 12 to 15).....$100 Summer Senior Soccer (Ages 16 to 18).....$100 Summer TORSO Soccer...... $85 Summer Adult Soccer..... $85
CC #s are Encrypted
Credit Card No
Expiration	01 02 03 04 05 06 07 08 09 10 11 12 / 2008 2009 2010 2011 2012 2013 2014 2015
Privacy Code	(last 3 digits from the back of the card)

- Credit Cards are Encrypted, however you may call 936-321-1001 ext. 231 to submit your credit card # -

WAIVER OF LIABILITY AND RELEASE AGREEMENT
I hereby release, discharge and/or otherwise indemnify JOPA Sports, its employees and associated personnel, including the owners of arenas and facilities utilized by the programs, against any claims by or on behalf of the registrant as a result of the registrants participation in the program and or being transported to or from the same, which transportation I hereby authorize. As the parent/guardian of the above named player, I hereby give consent for emergency medical care prescribed by a duly licensed doctor of medicine. This care may be given under whatever condition necessary to preserve the life, limb or well being of the dependent. I hereby give my approval and consent to both statements.
IMPORTANT! By submitting registration below, you indicate that you have read and understand the above waiver and your submission is equivalent to your signature on said waiver.