Blank Registration Form (Drayton Minor Soccer)

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Click to Download Registration_Form_2019

Drayton Minor Soccer Registration Form

Name:

LAST

FIRST

Address:

Street

City

Postal Code

Phone:

 

Date of Birth:

Age Group:

Email:

 

Gender:

 

Parent’s Names

 

OSA #:

 

 

Medical Issues:

 

Club Registration #

CD046427

Club Name:

Drayton Minor Soccer

Playing History:

Played Before □ Never Played Before

Fees:

Uniform Deposit _____ Registration Fee ______ Late Fee _____

 

CONSENT FOR USE OF PERSONAL INFORMATION AND PUBLICATION:                                                                                       
I authorize the Canadian Soccer Association, the Ontario Soccer Association, SWRSA, NPSL and Drayton Minor Soccer (DMS) to collect and use personal information about me and or my child/ward for the purpose of receiving communications from the Ontario Soccer Association, SWRSA, NPSL, League and Club.

I authorize the use of

1.       personal information and/or        ______ (initial)

2.       photographs                                    ______ (initial)

of my son/daughter to be used within Drayton Minor Soccer publications. Personal information that may be posted would include: Stats, awards, prizes, or accomplishments achieved by my son/daughter, events or activities that my son or daughter may be involved, Year of Birth of my son or daughter DMS Publications may include: the Drayton Minor Soccer web site (www.draytonminorsoccer.ca), Newspapers, and Newsletters. This information can be viewed by anyone that accesses the Drayton Minor Soccer website, or publications, and if consent were withheld, this posting and publication would not occur. I give this consent voluntarily, and understand that I may withdraw this consent at anytime, in writing.

 

ACCEPTANCE OF TERMS AND CONDITIONS:

In consideration of the acceptance of my or my child/ward’s membership in the Ontario Soccer Association, SWRSA, NPSL, District Association and Club, I, the participant and parent/guardian (if participant is under 18 years of age), agree as follows:

1.         I understand that I or my child/ward cannot play in any sanctioned soccer game until after this registration form has been validated and the registration data has been entered in The Ontario Soccer Association’s computerized registration system.

2.        I have reviewed the waiver/participation agreement attached and my signature affixed hereto indicates my agreement with such waiver/participation agreement.

3.        I am aware of The Ontario Soccer Association, SWRSA, Drayton Minor Soccer, NPSL and League bylaws, policies, rules, and regulations and agree to abide by them and to be bound by them.

4.        I accept sole responsibility for my or my child/ward’s personal possessions and athletic equipment.

5.        I accept all liability for any damage to the playing equipment caused by me or my child/ward’s careless, negligent and/or improper handling.

I acknowledge that I have read this registration agreement in its entirety and that I have executed this registration agreement voluntarily and agree to the Terms and Conditions listed on page 2.     

 

                                                                                                                                                                 

Signature of Participant (if age 18 or over)/Parent/Guardian                                      Date

 

 

 

For Use by Club

Verification of Birth Date

Birth Certificate Other______________________

Club Official’s Signature

 

 

Date:

 

Registration Cheque #

Uniform Cheque #

 

 

 

 

 

PARTICIPATION AGREEMENT FOR THOSE UNDER 18 YRS

By signing this document you will waive certain legal rights, PLEASE READ CAREFULLY. IN CONSIDERATION of allowing my minor child/ward to participate in the programs, activities and events of Minor Soccer, I ASSURE TO YOU THAT:

1.       I am the parent/guardian of the above named participant having full legal responsibility for decisions regarding the above named participant.

2.       I believe that my minor/ward is physically, emotionally and mentally able to participate in the programs, activities and events of DMS.

3.       I hereby acknowledge that I am aware of the risks and hazards associated with or related to soccer.    The risks and hazards include, but are not limited to injuries from:

 

a. Executing strenuous and demanding physical techniques in soccer;

b. Dry land training including weights, running and massage;

c. Grass, turf and other surfaces including bacterial infections and rashes;

d. Falls to the ground due to uneven or irregular terrain or surfaces;

e. Collisions with walls and soccer equipment;
f. Failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment;

g. Extreme weather conditions which may result in heatstroke, sunstroke or hypothermia;

h. Contact, colliding or being struck by other participants, spectators, equipment or vehicles;

i. Vigorous physical exertion and strenuous cardiovascular workouts;

j. Exerting and stretching various muscle groups; andk. Travel to and from competitive events and associated non-competitive events, which are an integral part of the organization’s activities.

 

4.       Furthermore, I am aware that my child/ward may:

 

a. Sustain injuries in soccer that can be severe, cause spinal cord injuries and even be fatal;
b. Experience anxiety while challenging himself/herself during the activities, events and programs;
c. Come into close contact with other participants, including the possibility of accidental and unexpected contact;

d. Risk of injury is reduced if he/she follows all rules established for participation; and
e. Risk of injury increases as he/she become fatigued. I UNDERSTAND AND AGREE, on behalf of myself, my heirs, assigns, personal representatives and next of kin that my signing of this document constitutes:

 

5.       I am registering my child/ward willingly and my child/ward is participating voluntarily in these activities, events and programs.

6.       I agree that there are risks in soccer as described above and my child/ward will be exposed to these risks and hazards.

7.       I agree to accept all these risks and hazards and be responsible for any injury or other loss, which my minor child/ward might receive while participating in these events, activities and programs.

8.       If something happens to my child/ward, I release the Organizers of responsibility for any claims, demands, actions and costs, which might arise out of my child/ward’s participation. I understand “Organizers” to mean: District Associations, Leagues, Clubs and their directors, officers, members, employees, volunteers, officials, participants, clubs, agents, sponsors, owners/operators of facilities, and representatives. 

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Printed from draytonminorsoccer.ca on Wednesday, March 20, 2019 at 1:36 PM