Erin Mills Soccer Club Registration/Tax Receipt
Erin Mills Soccer Club Inc.
Club # CD 25-20
3135 Unity Dr #3, 4, Mississauga ON L5L 4L4
Tel 905-820-9740 Fax 905-820-5412
Website: www.erinmillssoccer.com Email: [email protected]
Program and Registration Detail
Registration ID
Registration Date
Program Type
(MM-DD-YY)
Rep
Program
Group
Gender
Summer
2012
Player Info
OSA Number
Last Name
Address
City
Primary Phone
Alternate Phone 2
Email Address
Medical
Date of Birth
First Name
(MM-DD-YY) Gender
Province
Alternate Phone
Extension
Middle Name
Unit Number
Postal Code
Fax Number
Parents/Guardians
Would you be interested in becoming a: Coach
Assistant Coach
Convenor
Sponsor
Consent For Use Of Personal Information
I authorize the Ontario Soccer Association, the Peel- Halton Soccer Association, South Region and Ontario Youth Soccer Leagues and the Erin Mills Soccer Club Inc.
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 [email protected] 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 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:
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/We agree to the publication of my/our pictures and names in any non-commercial medium, including websites, the club the O.S.A. and/or its sponsors uses to
publicize its activities.
3.
The Club reserves the right to assign players to any team, move players and otherwise equalize teams, including combining age groups for competitive
purposes, at its discretion. Individual player requests to play up must be approved by the club.
4.
An Administrative Fee of $50.00 will apply to all refunds. Refunds will not be approved after the 2nd scheduled game. No refunds are provided to competitive/
select players at any time unless the player has been cut from the team. The Customer or Pink copy of the registration must be attached to any refund request –
No Exceptions. Transfer of payment to another season can only be implemented once, if you fail to participate in the transferred program you will not be granted a
refund. Transfer of payment is only valid for one year from the date the transfer was issued. A credit receipt will be issued for transfer payments, this will be
mailed to you. A charge of $35 will be issued for NSF cheques, replacement cheques will not be accepted (must be paid by either cash/credit or debit).
5.
I have reviewed the waiver/ participation agreement attached and my signature affixed hereto indicates my agreement with such waiver/ participation
agreement.
6.
I am aware of the Ontario Soccer Association, The Peel- Halton Association, The Erin Mills Soccer Association Inc. and league by laws, policies, and regulations
and agree to abide by them and to be bound by them.
7.
I accept sole responsibility for my or my child/ward’s personal possessions and athletic equipment.
8.
I accept all liability for any damage to the equipment caused by me or my child/ward’s carless, 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 Participant (if aged 18 & over)
Signature of Parent/Legal Guardian (if under 18)
Date of Signing (mm/dd/yyyy)
Payment Info (Office Use Only)
Payment Method
Notes/Team Name/Coach
Registration Amount
Requests
Staff Initials
Please note that the club cannot guarantee player placement requests
PRIVACY CODE CONSENT FORM
CONSENT - USE OF PERSONAL INFORMATION
“The undersigned is a member of the Erin Mills Soccer Club (“EMSC”) as a Player and/or as the
Parent or Legal Guardian of a Player(s). As a member of EMSC, the Undersigned hereby
acknowledges as follows:
1. that they have been provided with a copy of EMSC’s Privacy Code and that they have
read and understand its contents;
2. that they have completed one or more EMSC/OSA Registration Forms personally or
for as Associated Player(s) and understand what information is being disclosed to EMSC;
3. that they understand the purpose for which the information has been collected by
EMSC and how this information may be used by EMSC, its staff, directors, conveners, coaches,
managers, volunteers, and related organizations;
4. that they have freely and voluntarily disclosed personal information concerning
themselves, their children or the children for whom they are legal guardians;
5. that they understand that they can revoke their consent by delivering written notice
to this effect to EMSC at any time;
6. that they acknowledge that if they revoke their consent it could affect the ability of
EMSC to continue to offer its Programs and Services to the Member or to the Associated
Player(s); and
7. that EMSC does not share, give, rent or sell client information to any organization or
individual except to comply with laws, or regulations of a government to regulatory body in
response to a valid subpoena, warrant, or order, or to protect the rights of EMSC or any of its
players, coaches, managers, team staff, employees or volunteers.
ONTARIO SOCCER ASSOCIATION
Participant’s Agreement (To Be Used for Players Under the Age of 18)
ALL PROGRAMS AND ACTIVITIES HAS ITS RISK
I participate in the game of soccer because it is physically and mentally challenging. In consideration of my
participation in such programs, activities and events, I hereby acknowledge that I am aware of the risks and
hazards associated with or related to this activity. The risks and hazards include, but are not limited to:
• Injuries from executing strenuous and demanding physical techniques in soccer;
• Injuries from dryland training including weights, running and massage;
• Injuries from grass, turf and other surfaces including bacterial infections and rashes;
• Injuries resulting from falls to the ground due to uneven or irregular terrain or surfaces;
• Injuries from collisions with walls and soccer equipment;
• Injuries resulting from failure to properly use any piece of equipment or from the mechanical failure of
any piece of equipment;
• Spinal cord injuries which may render me permanently paralyzed;
• Injuries from extreme weather conditions which may result in heatstroke, sunstroke or hypothermia;
• Injuries from contact, colliding or being struck by other participants, spectators, equipment or vehicles;
• Injuries resulting from vigorous physical exertion and strenuous cardiovascular workouts;
• Injuries from exerting and stretching various muscle groups; and
• Travel to and from competitive events and associated non-competitive events which are an integral
part of the organization’s activities.
Furthermore, I am aware:
• That injuries sustained in soccer can be severe;
• That I may experience anxiety while challenging myself during the activities;
• That I may come into close contact with other participants, including the possibility of accidental and
unexpected contact;
• That my risk of injury is reduced if I follow all rules established for participation; and
• That my risk of injury increases as I become fatigue.
I AGREE TO BE RESPONSIBLE FOR MYSELF
I am participating voluntarily in these activities, events and programs. I agree that there are risks in soccer as
described above. By participating voluntarily in these events, activities and programs, I am exposed to these
risks and hazards. I agree to accept them and be responsible for any injury or other loss which I might receive
while participating in these events, activities and programs.
If something happens to me, I release the organizers of responsibility for any claims, demands, actions, and
costs which might arise out of my participation. In this Agreement 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, owers/operators of facilities, and
representatives.
I ACKNOWLEDGE MAKING THIS AGREEMENT
I have read and understood the terms and conditions of this agreement, and by signing it voluntarily, I
am agreeing to abide by these terms.