The Ontario Soccer Association - Player Registration Form

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THE ONTARIO SOCCER ASSOCIATION - PLAYER REGISTRATION FORM
PERSONAL INFORMATION
Full Name:
Last
First
M.I.
Address:
Street Address
Apartment/Unit #
City
Province
Postal Code
Home Phone:
(
)
Alternate Phone:
(
)
Fax Number:
E-mail Address:
Birth Date:
Proof of Birthdate:
Gender:
(y/m/d)
OSA Registrant Number:
OHIP Number (Optional)
*OHIP Numbers are optional to collect and an optional field for this form*
TEAM DETAILS
Club Registration Number:_____________________________ Club Name: _______________________________
Season Type: ______ Indoor ______ Outdoor
Player Classification:
Indoor:
l
__Mini Indoor __Youth Indoor __Senior Indoor __Pro Indoor
__Mini Futsal __Youth Futsal __Senior Futsal __Pro Futsa
Outdoor:
__Mini Outdoor __Youth Competitive __Youth Recreational __Senior Competitive __Senior Recreational __Pro Outdoor
Team Registration Number: ______________________ Team Name: ________________________
League Registration Number: ______________________League Name: ______________________
Division Registration Number: _____________________ Division Name: ________________________
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 suspended from all Ontario Soccer Association activities for
one year.
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 Ontario Soccer Association and _________________ Club to collect and use personal information about
me or my child/ward for the purpose of receiving communications from the Ontario Soccer Association and Club.
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 membership in the Ontario Soccer Association, District Association and Club, I, the participant,
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.
I have reviewed the participant’s agreement attached and my signature affixed hereto indicates my agreement with such waiver
2.
3.
I am aware of The Ontario Soccer Association, _____________ Club 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.
5.
I accept all liability for any damage to the playing equipment caused by me careless, negligent and/or improper handling.
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.
___________________________________________________
_________________
Signature of Participant (if aged 13 and over)
Date
___________________________________________________
_________________
Signature of Parent/Guardian (if player is under 18)
Date
For use by CLUB REGISTRAR
Governing Organization Signature
____________
Verification of Birthdate: __ Birth Certificate ___ Player Book ___ Other
__________________
Date
SIGNATURE____________________ Date ___________________

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