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[FITNESS, SPORTS & RECREATION] Soccer Registration + Payment (Under 18)
[FITNESS, SPORTS & RECREATION] Soccer Registration + Payment (Under 18)
[ENTER ORGANIZATION NAME] player registration form [ENTER ORGANIZATION NAME, ADDRESS] Phone:
(123) 456-6789
Email:
YourName@YourEmail.com
Website:
YourWebsite.com
PLAYER INFORMATION
Please complete the following
Player's name
First
Last
Gender
*
Male
Femaile
Player date of birth (DD/MM/YY)
Scan Barcode
Age (as of January 1, 2014)
Scan Barcode
Please upload a photocopy of the player's birth certificate. Alternatively, you can provide it in-person at your child's orientation.
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Attach Files
Player is registering for
*
Under 6 (co-ed) $80
Under 8 (co-ed) $90
Under 10 (co-ed) $100
Under 12 $120
Under 14 $150
Player T-shirt size
*
Child small
Child medium
Adult small
Adult medium
Adult large
Adult XL
Home phone
*
-
###
-
###
####
Address
No Preference
Work
Home
Delivery
Address Type
Street Address
Address Line 2
Apartment
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
PARENT OR GUARDIAN INFORMATION
Please complete the following
Parent or Guardian 1 name
*
First
Last
Parent or Guardian 1 phone number (cell or business)
*
-
###
-
###
####
Parent or Guardian 1 email address
*
Scan Barcode
Confirm Email
*
Parent of Guardian 1 relationship to player
*
Mother
Father
Aunt
Uncle
Grandmother
Grandfather
Other
PARENT OR GUARDIAN 1: Our organization relies on the help of parents and others. Please check the following if you are able to volunteer as:
Assistant Coach
Board Member
Coach
Other
Referee
Saturday morning soccer Coach
Saturday morning volunteer
Team Manager
Parent or Guardian 2 name
First
Last
Parent or Guardian 2 phone number (cell or business)
-
###
-
###
####
Parent or Guardian 2 email address
Scan Barcode
Confirm Email
*
Parent or Guardian 2 relationship to player
*
Mother
Father
Aunt
Uncle
Grandmother
Grandfather
Other
PARENT OR GUARDIAN 2: Our organization relies on the help of parents and others. Please check the following if you are able to volunteer as:
Assistant Coach
Board Member
Coach
Other
Referee
Saturday morning soccer Coach
Saturday morning volunteer
Team Manager
PLAYING HISTORY
ATTENTION:
The information below must be completed.
Any person who withholds or provides false information will be suspended from all [ENTER ORGANIZATION NAME] activities for one year.
You must answer the question(s) below
Has the player ever registered to play soccer in another country?
*
Yes
No
If yes, in which country did the player last register?
Scan Barcode
If yes, with which Club did the player last register in that country?
Scan Barcode
In which year did the player last register in another country?
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
CONSENT FOR USE OF PERSONAL INFORMATION
I authorize the [ENTER ORGANIZATION NAME AND/OR AFFILIATES] to collect and use personal information about my child/ward for the purpose of receiving
communications from the [ENTER ORGANIZATION NAME AND/OR AFFILIATES].
I understand that I may withdraw such consent related to receiving communications at any time by contacting the [ENTER ORGANIZATION NAME] Privacy Officer at: [ENTER CONTACT INFO].
The Privacy Officer will advise the implications of such withdrawal.
**[ENTER ORGANIZATION NAME] does not sell or distribute your personal information to any other third party not listed herein.**
Please read the info below
ACCEPTANCE OF TERMS AND CONDITIONS
In consideration of the acceptance of my child/ward’s membership in the [ENTER ORGANIZATION NAME], I, the parent/guardian (for the participant under 18 years of age), agree as follows:
1. I understand that 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 [ENTER ORGANIZATION NAME]'s computerized registration system.
2. I have reviewed the participation agreement above and my signature below hereto indicates my agreement with such participation agreement.
3. I am aware of [ENTER ORGANIZATION NAME AND/OR AFFILIATES] 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 child/ward’s personal possessions and athletic equipment.
5. I accept all liability for any damage to the playing equipment caused by my child/ward’s careless, negligent and/or improper handling.
By signing and dating below, I agree that I am the the parent or legal guardian of the player being registered and to be bound by this Legal
Agreement even if I have not read the above agreement
Signature of Parent or Legal Guardian
*
Redo
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Signed on this date
*
/
MM
/
DD
YYYY
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FOR USE BY CLUB REGISTRAR ONLY
Enter a description for your sectional break
Player's birth date verified by:
Birth certificate
Player book
Other
=
Player paid by:
Online form
Cheque
Cash
Bank draft/money order
Credit card
If paid by "cheque," cheque number:
Scan Barcode
Payment received on this date
/
MM
/
DD
YYYY
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$
0
Total
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