Please complete the registration form below. Should you have any questions please connect with a member of our staff.

If you prefer to complete a paper copy it can be downloaded below.

Program Registration Form

(Please use one form for each child.)

Participant Information

Participant First Name

Participant Last /Sur Name

Date of Birth

Age

Gender

Grade

Language(s) Spoken

Home Address

School/Program

Holy Angels Catholic School (must be a current student of the school)

St. John De La Salle (must be a current student of the school)

Chatman Tuley Park Soccer

Parent/Guardian Information

Parent/Guardian 1 First and Last/Sur Name

Relationship

Address

Phone

Parent/Guardian 2 First and Last Name (Optional), Relationship, and Phone

Emergency Contact Information (someone other than a parent/guardian)

First and Last/Sur Name

Phone

Communication Preference

If there is a change in schedule, who is the best person to contact? Please provide name and best form of contact (phone or text).

Name, Phone, and Communication Preference (phone or text)

Permission and Release

As the parent/legal guardian of the above stated child, I hereby give my permission for him/her to participate in CJ Brown Foundation (CJBF) programming, including athletic activities and program related transportation. I understand that there are risks associated with participation in sports and travel and agree and hold harmless CJBF, its coaches, employees and volunteers (collectively "Covered Parties" from any claim of personal injury, illness, or damages of any kind.

Photography/Video & Media

As the parent/legal guardian of the above stated child, I herby give CJ Brown Foundation (CJBF) permission to obtain and use his/her likeness (photo, video, etc.) for CJBF-related publications, promotional purposes, website, media press releases or other similar purposes linked to the CJBF programs. I hereby give my permission for him/her to have limited supervised interaction with the media in line with the program's goals and policies.