Jaffrey Youth Soccer Permission Slip

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Participant(s)                        Grade:            Gender: M/F            Age:        

1._____________________________________________________________________

2._____________________________________________________________________

I hereby give permission for my child to participate in the soccer program sponsored by the Jaffrey Recreation Department.  I am aware of and assume all risks and hazards incidental to such participation,  and I do hereby waive, release and agree to hold harmless the Town of Jaffrey, its Recreation Dept., sponsors, volunteers and staff, for any claim arising out of injury to my son/daughter or property damage that might occur. I also certify that there is a registration form on file with the department and that the information is correct.

Parent Signature________________________________ Phone #________________Date__________

Address____________________________________________Yes I can coach___