Mail To:
Jupiter Lanes
Attn: JTAA
350 Maplewood Dr
Jupiter, FL 33458
Player Information
Last Name:
First Name:
MI:
Birth Date:
Phone:
Address:
City:
State:
Zip:
JTAA Boundaries: North of Donald Ross Road to CR 714 in Palm City.
Father's
Information
Last Name:
First Name:
Occupation:
Work Phone:
Mother's
Information
Last Name:
First Name:
Occupations:
Work Phone:
Parent Email:
Emergency
Information
Contact:
Phone:
Relationship:
Doctor:
Parents attended PAYS course:
Yes No
Player's Age as of
start of bowling season, Jan. 21, 2002:
Please
Indicate Interests: (see form below)
Coach:
League
Dir:
Sponsor:
Check if New Address:
NYSCA Certified:
1. The player, parents, and relatives agree to abide by the rules and
regulations set by the JTAA for the health, safety, and welfare of the
players.
2. All equipment issued to the players must be maintained and returned
to the JTAA. The JTAA is not responsible for articles of clothing or
personal belongings lost, damaged, or stolen.
3. I hereby grant permission for my child to participate in the
registered JTAA activity. In the event of injury, illness or other
medical emergency to my child, I hereby grant authority to a licensed
physician, licensed osteopath physician, or other qualified emergency
services personnel to render such emergency medical treatment as may be
deemed necessary under the circumstances. Further, I hereby authorize
the JTAA to act for me according to their best judgment in any emergency
requiring medical attention. I understand that organized youth activity
programs such as those offered by the JTAA involve risk of injury to my
child or property and in consideration of my child's participation in
the registered JTAA activity, I waive, release, absolve, and hold
harmless the JTAA, its Directors, Sponsors, volunteers, and coaches;
persons transporting my child to and from activities; and all other
participants from any claim arising out of injury, or damage to my child
or property while participating. 4. Your cancelled check will act as
your receipt.. 5. In all sports, any insurance carried through the
JTAA acts as a secondary policy only!
Parent or Guardian Signature:___________________________
