Hanna & District Minor Soccer Association
Player Name:________________________________M F
Birthday (MM/DD/YY): _____________________________________________
Age as of December 31st (of last year): ___________________________________
$75 Under 12, Under 14, Under 16, Under 18
$55 Under 8, Under 10,
$45 Under 6
$20 Under 4 CHQ:_______ Cash:________
Alberta Health Care #____________________________________________
Street Address: ________________ _____________Mailing Address:_______________________________
Phone (res):_______________________________Phone (cell / work):______________________________
EMAIL (THIS WILL BE OUR MAIN FORM OF COMMUNICATION):___________________________________
Hanna Minor Soccer needs volunteers, which of the following would you be interested in:
U4 coach, U6 coach, your child’s team manager, U4-U10 tournament committee, bylaw development,
H&DMSA LIABILITY RELEASE
The parent and/or guardian accept the liability and risk associated with soccer as a contact sport and release the H&DMSA from
any claim, demands, damages, actions or causes of action arising out of or in consequence of any loss, injury or damage to the
player incurred while participating in an H&DMSA / ASA game. I do hereby give H&DMSA as represented by an executive
member, coach referee, or manager permission of obtain medical aid if they feel it is required.
My child / ward has no physical impairment, illness, or allergy that might affect his participation or safety.
If so state reason:_______________________________________________________________________________
The parent and/or guardian consent to the H&DMSA collecting, using and disclosing the player registration information for all
soccer participation registration requirements, including but not limited to, H&DMSA, BCSA, ASA, CSA and provincial affiliated
Throughout the year, photos may be taken of children involved in Soccer activities. These photos may be posted on the web site
or printed in the newspaper. Unless otherwise stated below, I consent to the use of images of my child/ward as indicated.
____I DO NOT wish to have images used as indicated above.
Parents/Guardian (print names): ___________________________________________________________