Rovers Registration Indoor7 by mpU36R

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									                       VSA Rovers Registration                                                                                  Publishi
                      2012/13 Indoor Season


                                                                         Registration #:
                                          Player Information                                                               I,
Player Name:                                                Gender:                      M                   F
Address:                                                    City:
Phone #:                                                    Birth Date:
Health #:                                                                                                                                  Print Firs


Medical Conditions:                 Yes            No       (If Yes, please state below)
                                                                                                                           named player to
Has player previously played with VSA Rovers?                                      Yes                  No
                            Parent / Guardian Information
              Father                                        Mother
Parent Name:                                                                                                               Select only those
Address:
Home Phone:                                                                                                                Should I grant p
Cell Phone:                                                                                                                that only first na
Email:
Signature/s:
Are you willing to help?:                      Coach                 Manage                  Helper                              Parent/Guardian Sig


                                          Emergency Contact
Name:
Address:
Phone #:                                                    Cell #:
                                                  Age Group
Cheques made payable to:                  V.S.A. (Valley Soccer Association)
                                                                                           As parent/guardian
U12                   2001-2002                $375.00 U16                         $375.00
                                                                              1997-1998
                                                                                           competitive league
U14                   1999-2000                $375.00 U18                         $375.00
                                                                              1995-1996
                                                                                           Association for any
Division 2 player's pay an extra $100 turf fees on top of the above registration fees.     which he/she has e

Registrations may not be accepted after Oct 1, 2012. A separate cheque of $50.00 ir required for
a jersey deposit at registration, which is fully refundable upon return of jersey at the end of the
season. Jersey deposit cheques are to be post-dated to March 31, 2012.
                                                                                                                                 Parent/Guardian Sig
Cheques will be deposited immediatley after registration, when team numbers have been confirmed. Cheques of players who
have been released or do not make the team, will be shredded by the VSA. Under no other circumstance are the VSA obliged
to repay fees.
                                     OFFICE USE ONLY
                                                                                                                                       Above Dated
Method of payment:                        Cash / Chq          $               Chq # ______

Jersey Deposit Rec'd:                     Cash / Chq          $               Chq # ______
  Publishing Player/Team Photographs

                                       Permission Form
                                                          (Parent or Guardian) of
                  Print First and Last Name




                                                          (Player) give permission for the above
                Print First and Last Name




named player to have his/her photograh published via the following method/s:

     VSA Website                            VSA Flyers and Publications                      In Newspaper


Select only those that apply or                      all of the above


Should I grant permission for publication on the VSA website, I understand
that only first names are to be used.


      Parent/Guardian Signature                                           Player Signature




                                              Liability Waiver

As parent/guardian, I will allow the above registered player to participate in the sport of
competitive league soccer with the VSA Association. I will hold harmless the VSA
Association for any liability arising out of the participation of any soccer program to
which he/she has entered during the registered period.




      Parent/Guardian Signature




            Above Dated
understand

								
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