Central New Jersey Soccer Academy   
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 Registration Form
Name
Address
City
State
Zip
E-mail Address
Home Phone #
Business Phone #
Club Affiliation
T-Shirt Size 
Sex

Male Female
Method of Payment

Cash    Check      Credit Card
Parent / Guardian
Phone
Additional Comments
PARENT/GUARDIAN CONSENT AND WAIVER
I hereby represent that the above information is true and accurate and the named applicant is in good health and has my permission to participate in CNJSA Programs. I acknowledge that soccer is a contact sport and that there is a risk of injury from participating in  CNJSA and its related activities. I HEREBY WAIVE AND RELEASE Mohamed "Zizo" Sherif, CNJSA and its agents, servants and employees from any and all liability and claims for damages. In the event of an emergency I hereby give permission to such Medical personnel as necessary to render treatment.
Parent/Guardian Signature ______________________________________

For additional info, Send us an Email at info@cnjsa.com
or call us at (609) 903-0183
Print and send this form, along with payment to :
  • Central New Jersey Soccer Academy  
  • P.O. Box 1569
  • East Windsor, NJ 08520