The Ontario Soccer Association Multi Player Registration Form (Page 2 of 2) in pdf

THE ONTARIO SOCCER ASSOCIATION MULTI PLAYER REGISTRATION FORM - PAGE 2

PLAYER INFORMATION #3

Full Name:

Email:

Last

First

M.I.

Sex:

Birth Date:

Proof of Birthdate:

Birth Certificate

Old Card

Other

OSA Registrant Number:

OHIP Number (Optional) :

*OHIP Numbers are optional to collect and an optional field for this form*

TEAM DETAILS #3

Club Registration Number: CD - __ __ - __ __

Club Name: _____________________________________

Season Type: ___ Indoor ___ Outdoor

Player Classification:

Indoor: ___ Mini___ Youth___ Senior___ Pro

Outdoor: __Mini __Youth Competitive __Youth Recreational __Senior Competitive __Senior Recreational __Pro

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

Team Name: ___________________________________

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

League Name: __________________________________

Division Registration Number: D __ - __ __ __ __ __ __ - __ __ __ __ Division Name: ________________________

PLAYING HISTORY #3

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, (insert name of your District Association), and (insert name of your 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.*

*The OSA does 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, (insert name of your District Association), (insert name of your 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 #1 (If age 13 and over)

Signature of Player #2 (If age 13 and over)

__________________________________

________________________________________________

___________

Signature of Player #3 (If 13 and over)

Signature of Parent/Guardian (If any Player aged under 18)

Date

CLUB REGISTRAR SIGNATURE___________________________

OSA SIGNATURE___________________________

Date ____________________

Revised April 21, 2006

The Ontario Soccer Association Multi Player Registration Form Page 2

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