The Ontario Soccer Association Player Registration Form

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THE ONTARIO SOCCER ASSOCIATION
Player Registration Form
PLAYER INFORMATION
Last Name:
First Name:
Middle Initial:
Address:
City:
Prov.
Postal:
Home Phone:
(
)
Business Phone:
(
)
Cell Number:
E-mail Address:
Gender:
Birth Date:
OSA Registrant #:
(y/m/d)
OHIP # (Optional):
*OHIP Numbers are optional to collect
TEAM/CLUB DETAILS
Club/Academy Name:
Season Type:
Indoor
Outdoor
Player Classification
Indoor:
Grassroots
Youth
Senior
Futsal
Outdoor:
Grassroots
Youth Rec
Youth
Senior
Senior
Pro
Comp.
Rec
Comp.
Team Name:
Team Registration Number:
League Name:
League Registration Number:
Division Name:
Division Registration Number:
PLAYING HISTORY
ATTENTION: The “PLAYING HISTORY” section MUST be completed
– Any person who provides false information or withholds any
of the required information will be subject to Discipline by the Ontario Soccer Association.
Has the player ever registered to play soccer in another country? ___ Yes ___ NO
If Yes, answer the following questions:
a)
In which country (other than Canada) did the player last register? __________________________________
b)
With which Club did the player last register in another country?
__________________________________
c)
__________________
In which year did the player last register in another country?
_______________
CONSENT FOR USE OF PERSONAL INFORMATION
I authorize the Canadian Soccer Association, *Ontario Soccer Association, the applicable District Association and Soccer Organization to collect and use
personal information about me for the purpose of receiving communications from the Canadian Soccer Association, Ontario Soccer Association, District
Association, League and Soccer Organization. I understand that I may withdraw such consent related to receiving communications at any time by contacting
the OSA Privacy Officer at OSAPrivacyOfficer@soccer.on.ca or by mail to: Attention: OSA Privacy Officer, Ontario Soccer Association, 7601 Martin Grove
Road, Vaughan ON L4L 9E4. The Privacy Officer will advise the implications of such withdrawal.
*We do not sell or distribute your personal information to any other third party not listed herein.*
ACCEPTANCE OF TERMS AND CONDITIONS
In consideration of the acceptance of my or my child/ward’s membership in the Ontario Soccer Association, District Association and Club/Academy, I, the
participant, agree as follows:
1.
I understand that I 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 read and understand the waiver attached and my signature affixed hereto indicates my agreement with such waiver.
3.
I am aware of The Ontario Soccer Association, District Association and Club/Academy’s 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 personal possessions and athletic equipment and accept all liability for any damage to the playing equipment caused
by my careless, negligent and/or improper handling.
5.
I grant permission to the Organization to photograph and/or record my image and/or voice on still or motion picture film and/or audio tape and to use
this material to promote the sport of soccer and the Organizations through the media of newsletters, websites, television, film, radio, print and/or
other form. I understand I waive any claim to remuneration for use of audio/visual materials used for these purposes.
By signing and dating below you agree that you are the player being registered and to be bound by this Legal Agreement even if you have not read this
agreement.
___________________________________________________
___________________________________
_______________
Player Name or Parent/Legal Guardian if player is Under 18
Player Signature or Parent/Legal Guardian
Date
For use by CLUB/ACADEMY/LEAGUE REGISTRAR
DISTRICT ASSOCIATION/ONTARIO SOCCER ASSOCIATION VALIDATION
Verification of Birthdate: __ Birth Certificate ___ Player Book ___ Other
SIGNATURE: __________________________ DATE: _________________
SIGNATURE: __________________________ DATE: _________________
Note: Club must retain copy of the player registration form and if requested must submit form to its District Association or the Ontario Soccer Association upon request
Revised March 2016

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