Welland Soccer Club Senior Player Registration Form printable pdf download

SENIOR PLAYER REGISTRATION FORM

PLAYER’S PERSONAL INFORMATION (all information must be completed)

Full name:

Last

First

Initial

Address:

Street

City

Postal Code

Home Phone:

(

)

Alternate #:

(

)

Fax Number:

E-Mail address:

Birth Date:

Proof:

Birth Certificate

Health Card

Mon

Day

Year

Sex:

OSA Registrant #

TEAM DETAILS (office use)

CD - 20 - 26

Welland Soccer Club

Club Registration Number:

Club Name:

Season Type: ___ Indoor ___ Outdoor

Player Classification:

Indoor: ___ Senior___ Pro

Outdoor: ___Senior Competitive ___Senior Recreational ___Pro

Team Registration Number: TD - 20 __ __ - __ __

Team Name: ___________________________________

League Registration Number: L__ - 20 __ __ - __ __

League Name:

COED

MEN’s

VETERANS

SENIOR WOMEN

Division Registration Number: D __ - 20 __ __ __ __ - __ __ __ __ 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:

In which country (other than Canada) did the player last register? _____________________________________

With which Club did the player last register in another country?

_____________________________________

In which year did the player last register in another country?

_____________________

_______________

CONSENT FOR USE OF PERSONAL INFORMATION

I authorize the Ontario Soccer Association, Niagara Soccer Assn. and my Club to collect and use personal information about me or my

child/ward for the purpose of receiving communications from the Ontario Soccer Association, District Association, League and Club.

I understand that I may withdraw consent to collection, use or disclosure of my or my child/ward’s personal information at any time by

contacting the OSA Privacy Officer at OSAPrivacyOfficer@soccer.on.ca or by mail to: Attention of the OSA Privacy Officer, The

Ontario Soccer Association, 7601 Martin Grove Road, Vaughan ON L4L 9E4.

*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 and parent/guardian (if participant is under 18 years of age), agree as follows:

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 waiver/participation agreement attached and my signature affixed hereto indicates my agreement with such

waiver/participation agreement.

I am aware of The Ontario Soccer Association, Niagara Soccer Assn., my Club and League bylaws, policies, rules and regulations

and agree to abide by them and to be bound by them.

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

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.

_________________________________

__________________________________

____________________________

Signature of Player

Signature of Parent/Guardian (If under 18)

Date

CLUB REGISTRAR SIGNATURE

Entered in AIMS

Date:_____________________

___________________________

Revised 2010

Welland Soccer Club Senior Player Registration Form

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