South Dundas Soccer Association Seaway Kickers SSSL Registration Form 2012 Personal Information Please PRINT

Player Name: (First/Last) _______________________________________________________ Date of Birth: Month: ___________ Day: _________ Year: ___________ Gender: Female Male

Civic Address: __________________________________________________________________________ City: _____________________________________ Province: ______ Postal Code: ____________ Home Phone: Parent Cell Phone: _____________________________

Email: __________________________________________________________________ Parent/Guardian Name(s): (Please print) __________________________________________________ Signature of Parent/Guardian: ___________________________ Date: __________________________ Please Circle Players Size:

Please be sure to check sizes!!

JERSEY Youth M L XL Adult S M L XL

Name on jersey: ____________________________

Number on jersey: ____________

Player Fees
Fees are $115 payable by cash or cheque (to South Dundas Soccer Association). In addition to the traveling league registration form, a completed house league registration form must also be submitted ($40 fee). All NSF cheques will be charged all additional bank and administration fees. There is a $25 non-refundable fee. Full refund to all player who do not qualify for their team, or if there is no team in that division. It is mandatory for Kickers players to participate in the Saturday program unless otherwise authorized. **Players are supplied with shirts, shorts and socks as part of the registration fee.

Volunteering
SDSA Seaway Kickers cannot function without volunteers. Please help by indicating your willingness to volunteer. ___ Coach ___ Assistant Coach ___ Tournament ____ Committee Member ___ Trainer ___ Equipment Manager ___ Kickers Coordinator ____ Field Maintenance ___ Other ___ Web Site Maintenance ___ Canteen

Fee paid: $115 cash/chq

Cheque #: ______

Signature of Club Registrar: ________________________________________ Dated: _______________ Notes:

**PLEASE SIGN CONSENT ON REVERSE OF FORM**

South Dundas Soccer Association Seaway Kickers SSSL Registration Form 2012
Consent for Use of Personal Information I authorize the Canadian Soccer Association, the Ontario Soccer Association, the South Side Soccer League and the South Dundas Soccer Association to collect and use personal information about me or my child for the purpose of receiving communications from the Ontario Soccer Association, District, League and Club. I understand that I may withdraw such consent related to receiving communications at any time by contacting the OSA Privacy Officer at [email protected] 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. *SDSA does not sell or distribute your personal information to any other third party. Acceptance of Terms and Conditions 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. 2. I have reviewed the waiver/participation agreement attached and my signature affixed hereto indicates my agreement with such waiver/participation agreement. 3. I am aware of The Ontario Soccer Association, South Dundas Soccer Association and League bylaws (SSSL, EODSA League, ERSL and/or OYSL), policies, rules and regulations and agree to abide by them and to be bound by them. 4. I accept sole responsibility for my or my child's personal possessions and athletic equipment. 5. I accept all liability for any damage to the playing equipment caused by me or my child's careless, negligent and/or improper handling. Participation Agreement I ASSURE TO YOU THAT: 1. I am the parent/guardian of the above named participant having full legal responsibility for decisions regarding the above named participant. 2. I believe that my child is physically, emotionally and mentally able to participate In the programs, activities and events of The South Dundas Soccer Association and the South Side Soccer League. 3. I hereby acknowledge that I am aware of the risks and hazards associated with or related to soccer. The risks and hazards include, but are not limited to injuries from: a. Executing strenuous and demanding physical techniques in soccer; b. Dry land training including weights, running and other drills; c. Grass, turf and other surfaces including bacterial infections and rashes; d. Falls to the ground due to uneven or irregular terrain or surfaces; e. Collisions with walls and soccer equipment; f. Failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment; g. Extreme weather conditions which may result in heatstroke, sunstroke or hypothermia; h. Contact, colliding or being struck by other participants, spectators, equipment or vehicles; i. Vigorous physical exertion and strenuous cardiovascular workouts; j. Exerting and stretching various muscle groups; and k. Travel to and from competitive events and non-competitive events which are an integral part of the organization's activities. 4. Furthermore, I am aware that my child/ward may: a. Sustain injuries in soccer that can be severe, cause spinal cord injuries and even be fatal; b. Experience anxiety while challenging himself/herself during the activities, events and programs; c. Come into close contact with other participants, including the possibility of accidental and unexpected contact; d. Risk of injury is reduced if he/she fellows all rules established for participation; and e. Risk of injury increases as he/she become fatigued. I UNDERSTAND AND AGREE, on behalf of myself, my heirs, assigns, personal representatives and next of kin that my signing of this document constitutes: 5. I am registering my child/ward willingly and my child/ward is participating voluntarily in these activities, events and programs. 6. I agree that there are risks in soccer as described above and my child/ward will be exposed to these risks and hazards. 7. I agree to accept all these risks and hazards and be responsible for any injury or other loss which my minor child/ward might receive while participating in these events, activities and programs. 8. If something happens to my child/ward, I release the Organizers of responsibility for any claims, demands, actions and costs which might arise out of my child/ward's participation. I understand "Organizers" to mean: The Ontario Soccer Association. District Associations. Leagues, Clubs and their directors, officers, members, employees, volunteers, officials, participants, clubs, agents, sponsors, owners/operators of facilities, and representatives. I acknowledge that I have read this registration agreement in its entirety and that I have signed this agreement voluntarily. Parent/Guardian Signature: __________________________________________________________

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