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Register For Just4Keepers USA

Upon Completion of this form you will be forwarded to the Payment Page!You MUST complete the payment for your registration to be complete.Upon receipt of payment, you will be forwarded a Confirmation email

Contact Information

Keeper First Name

Last Name

Date of Birth

Gender

High School Graduation Year

Address

Street Address

Address Line 2

Cell Phone

Home Phone

City

Country

State / Province / Region

Primary Email Address

Secondary Email

Find Out About Just4Keepers?

Which Club do you Currently Play For?

If Other, Please Specify

J4K Keeper who referred you? (If Applicable),

Select the J4K USA Program You Are Registering For

Welcome Package

J4K Gloves/Academy T-Shirt (Glove Style and Color may Vary)
Need Sizing Assitance? For Assistance with sizing, Please visit the Link below

Gloves - Select Size

Shirt Size - Select Size

Parent/Guardian Consent

I hereby consent to any and all health services necessary by Just 4 Keepers staff to refer my child for consultation to any licensed medical specialist or to any area Emergency Room. I give authority and power to any such physician/surgeon to render any and all health services that may be deemed necessary or advisable. I authorize the Just 4 Keepers Director to accompany my child and sign permit forms required by the Medical Counter. I understand in case of serious accident or illness every effort will be made to contact me. I understand I will be responsible for any costs or care provided.

Parent/Guardian First Name

Last Name

Do You Consent

Date of Consent

Comments or Questions

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