Release of Liability Forms and Participant Agreement by qco11598

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									        Gloucester Dragons Recreational
  Gloucester Dragons Recreational Soccer Soccer
                                                                                                                                        1-5510 Canotek Road, Gloucester, ON, K1J 9J4
                              2011 PLAYER REGISTRATION FORM                                                                              Phone: 613-749-4029 - Fax: 613-749-9206
                                                                                                                                                   email: info@dragonsoccer.ca

 PLAYER INFORMATION
  Last Name                                                                           First Name                                                                        Initial


  Birth Date                                                                                                                            Language

                            Day               Month                 Year                  Male              Female                                    English         French       Bilingual

  Address                                                                                    City                                     Postal Code

  Home Phone                                   Number of years playing soccer                           For what Organization?

  email:

 IMPORTANT NOTE:                   Nights of play are TENTATIVE.           These could change depending upon the number of teams/players for this year.

 Special Request        Please indicate if you have any specific requirements pertaining to your child's ability to play soccer. Completion of this section by
  the parent does not guarantee that the request will be met. The Age Group Director will evaluate and action to the best of their ability and
  circumstances. NOTE: After April 10, 2011 no special requests will be entertained.


 PARENT / GUARDIAN INFORMATION 1
  Last Name                                                                           First Name                                                                        Initial

  Address                                                                                                                                Postal Code

  Home Phone                                          Work Phone                                     Cell                               Relationship to Player

  email:

 PARENT / GUARDIAN INFORMATION 2
  Last Name                                                                           First Name                                                                        Initial

  Address                                                                                                                                Postal Code

  Home Phone                                          Work Phone                                     Cell                               Relationship to Player

  email:

 PLAYING HISTORY                   This section MUST be completed – any person providing false information or withholding any required information will be
                                   suspended from all Ontario Soccer Association activities for one year.
  Has the player ever registered to play soccer in another country? If YES, answer the following questions                         Yes                          No
  a) In which country (other than Canada) did the player last register?
  b) With which Club did the player last register in another country?
  c) In which year did the player last register in another country?

 VOLUNTEER – Place an "X" by the position AND under age group and gender
                                              Mixed Gender                                    Girls                                                           Boys
  Coach                                        5    6   7                    8    9    10    11 12          13   15      18          8       9       10      11 12        13      15      18
  Assistant Coach
  Convenor                                              Board of Directors                  Board Position of interest:

 PLAYER/PARENT/GUARDIAN STATEMENT
    1   I acknowledge that I have read, understood and agree to abide by the GDRS Code                                             Fees for 2011
        of Conduct set out in the GDRS Handbook.                                                                                                          PRIOR to             AFTER
                                                                                                                 Category
    2   I acknowledge that I have read, understood and signed the OSA Consent and                                                                          April 11            April 10
        Waiver Forms attached                                                               Micros (born 2003 to 2006)                                      $130                $180
                                                                                            Mini and Youth - (born 1993 to 2002)                            $170                  $220
                                                                                            For 3 or more children of the SAME family                20% Discount          20% Discount
                       Signature                                      Date

 IMPORTANT NOTES
               Please send written request (provide child and parent names, child’s year of birth, Deposit Reference Number, mailing address) A $20
  REFUNDS
               administration fee will be charged for refund requests received up to and including June 11th. NO REFUNDS after June 10th, 2011.
 FOR OFFICE USE ONLY                      Cheque                   Cash               $                                       Deposit Reference #
  Cheque for multiple children:                1                                                 2                                         3
                                               4                                                 5                                         6
 1. White – Registration                                                                                                                                              2. Yellow – Recipient

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                                                          Consent for Use of Personal Information
                               Must be completed and signed by parent, or Participant if 18 or older during playing season
I authorize the Canadian Soccer Association, The Ontario Soccer Association, The Ottawa Gloucester Soccer Association and The Gloucester Dragons to
collect and use personal information about me or my child/ward, for the purpose of receiving communications from the OSA, District, League and Club.

I understand that I may withdraw such consent at any time by contacting the OSA Privacy Officer at:               OSAPrivacyOfficer@soccer.on.ca
or by mail to: Attention OSA Privacy Officer, The Ontario Soccer Association, 7601 Martin Grove Road, Vaughan ON L4L 9E4. The Privacy Officer will advise
the implications of such withdrawal. *Your personal information is not sold/distributed to any other third party not listed therein.
In consideration of acceptance of membership in The OSA, District and Club, I agree as follows:
    1    I understand that no person can play in any sanctioned soccer game until 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 and my signature affixed hereto indicates my agreement with such waiver/participation agreement.

    3    I am aware of the Bylaws, policies rules and regulations of The OSA, The Ottawa Gloucester Soccer Association, and Gloucester Dragons and agree to
         be bound by them.
    4    I accept sole responsibility for my/my child’s/ward’s personal possessions and athletic equipment.
    5    I accept all liability for any damage to the playing equipment caused by my/my child’s/ward’s careless, 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 Parent/Guardian OR Participant if 18 or older                                                                            Date

                                                Participation Agreement / Waiver and Release of Liability
                                Must be completed and signed by parent, or Participant if 18 or older during playing season
 By signing this document, you will waive certain legal rights, PLEASE READ CAREFULLY
                                                                                            Date of Birth of
                       Printed Name of PLAYER                                     Age          PLAYER:                 Day              Month               Year
 By signing this form, you give up important legal rights. Please read carefully!
  This is a binding legal agreement. As a parent/guardian of a minor participant, or as the actual participant, in the programs, activities and events of the
  Ontario Soccer Association, Districts, Leagues and Clubs, the undersigned acknowledges and agrees to the following terms.
 Accident Insurance - Executing this agreement will not preclude you from accident insurance coverage, subject to the terms and conditions of The Ontario
 Soccer Association’s insurance policy.
 Disclaimer - The Ontario Soccer Association, Districts, Leagues and Clubs, their directors, officers, members, employees, coaches, volunteers, officials,
 participants, clubs, agents, sponsors, owners/operators of facilities, and representatives (the “Organization”) are not responsible for any injury, damage or loss
 of any kind suffered by a participant during, or as a result of, any program, activity or event, caused in any manner whatsoever including, but not limited to, the
 negligence of the Organization.
 Description of Risks
 In consideration of participation in such programs, activities and events, I hereby acknowledge that I am aware of the risks and hazards associated with or
 related to soccer. The risks and hazards of soccer include, but are not limited to injuries from:
    1 executing strenuous and demanding physical techniques in soccer;
    2 dryland training including weights, running, and massage;
    3 grass, turf and other surfaces including bacterial infections and rashes;
    4 falls to the ground due to uneven or irregular terrain or surfaces;
    5 collisions with walls and soccer equipment;
    6 failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment;
    7 spinal cord injuries which may render the participant permanently paralyzed;
    8 extreme weather conditions which may result in heatstroke, sunstroke or hypothermia;
    9 contact, colliding or being struck by other participants, spectators, equipment or vehicles;
    10 vigorous physical exertion and strenuous cardiovascular workouts;
    11 exerting and stretching various muscle groups; and
    12 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:
    1 That injuries sustained in soccer can be severe;
    2 That participants come into close contact with other participants, including the possibility of accidental and unexpected contact;
    3 That participants may experience anxiety while being challenged during the activities;
    4 That risk of injury is reduced if all rules adopted during training are followed; and
    5 That risk of injury increases as participants become fatigued.
  Release of Liability
  In consideration of the Organization allowing the participant to take part in soccer activities, I agree:
  a) To assume all risks arising out of, associated with or related to such participation;
  b) To be solely responsible for any injury, loss or damage that may be sustained while participating; and
  c) To release the Organization from liability for any and all claims, demands, actions and costs that might arise out of such participation, even though such
  risks, injuries, loss, damage, claims, demands, actions or costs may have been caused by the negligence of the Organization.
  Acknowledgement - I acknowledge that I have read this agreement, that I have executed this agreement voluntarily, and that this agreement is to be binding
  upon myself, my heirs, executors, administrators and representatives.


                PRINT Name of Participant                                  Date                          Signature of Parent/Guardian OR Participant if 18 or older
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                                                          Consent for Use of Personal Information
I authorize the Canadian Soccer Association, The Ontario Soccer Association, The Ottawa Gloucester Soccer Association and The Gloucester Dragons to
collect and use personal information about me or my child/ward, for the purpose of receiving communications from the OSA, District, League and Club.

I understand that I may withdraw such consent at any time by contacting the OSA Privacy Officer at:               OSAPrivacyOfficer@soccer.on.ca
or by mail to: Attention OSA Privacy Officer, The Ontario Soccer Association, 7601 Martin Grove Road, Vaughan ON L4L 9E4. The Privacy Officer will advise
the implications of such withdrawal. *Your personal information is not sold/distributed to any other third party not listed therein.
In consideration of acceptance of membership in The OSA, District and Club, I agree as follows:
    1    I understand that no person can play in any sanctioned soccer game until 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 and my signature affixed hereto indicates my agreement with such waiver/participation agreement.

    3    I am aware of the Bylaws, policies rules and regulations of The OSA, The Ottawa Gloucester Soccer Association, and Gloucester Dragons and agree to
         be bound by them.
    4    I accept sole responsibility for my/my child’s/ward’s personal possessions and athletic equipment.
    5    I accept all liability for any damage to the playing equipment caused by my/my child’s/ward’s careless, 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 Parent/Guardian OR Participant if 18 or older                                                                            Date

                                                   Participation Agreement / Waiver and Release of Liability
 By signing this document, you will waive certain legal rights, PLEASE READ CAREFULLY
                                                                                            Date of Birth of
                       Printed Name of PLAYER                                     Age          PLAYER:                 Day              Month               Year
 By signing this form, you give up important legal rights. Please read carefully!
  This is a binding legal agreement. As a parent/guardian of a minor participant, or as the actual participant, in the programs, activities and events of the
  Ontario Soccer Association, Districts, Leagues and Clubs, the undersigned acknowledges and agrees to the following terms.
 Accident Insurance - Executing this agreement will not preclude you from accident insurance coverage, subject to the terms and conditions of The Ontario
 Soccer Association’s insurance policy.
 Disclaimer - The Ontario Soccer Association, Districts, Leagues and Clubs, their directors, officers, members, employees, coaches, volunteers, officials,
 participants, clubs, agents, sponsors, owners/operators of facilities, and representatives (the “Organization”) are not responsible for any injury, damage or loss
 of any kind suffered by a participant during, or as a result of, any program, activity or event, caused in any manner whatsoever including, but not limited to, the
 negligence of the Organization.
 Description of Risks
 In consideration of participation in such programs, activities and events, I hereby acknowledge that I am aware of the risks and hazards associated with or
 related to soccer. The risks and hazards of soccer include, but are not limited to injuries from:
    1 executing strenuous and demanding physical techniques in soccer;
    2 dryland training including weights, running, and massage;
    3 grass, turf and other surfaces including bacterial infections and rashes;
    4 falls to the ground due to uneven or irregular terrain or surfaces;
    5 collisions with walls and soccer equipment;
    6 failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment;
    7 spinal cord injuries which may render the participant permanently paralyzed;
    8 extreme weather conditions which may result in heatstroke, sunstroke or hypothermia;
    9 contact, colliding or being struck by other participants, spectators, equipment or vehicles;
    10 vigorous physical exertion and strenuous cardiovascular workouts;
    11 exerting and stretching various muscle groups; and
    12 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:
    1 That injuries sustained in soccer can be severe;
    2 That participants come into close contact with other participants, including the possibility of accidental and unexpected contact;
    3 That participants may experience anxiety while being challenged during the activities;
    4 That risk of injury is reduced if all rules adopted during training are followed; and
    5 That risk of injury increases as participants become fatigued.
  Release of Liability
  In consideration of the Organization allowing the participant to take part in soccer activities, I agree:
  a) To assume all risks arising out of, associated with or related to such participation;
  b) To be solely responsible for any injury, loss or damage that may be sustained while participating; and
  c) To release the Organization from liability for any and all claims, demands, actions and costs that might arise out of such participation, even though such
  risks, injuries, loss, damage, claims, demands, actions or costs may have been caused by the negligence of the Organization.
  Acknowledgement - I acknowledge that I have read this agreement, that I have executed this agreement voluntarily, and that this agreement is to be binding
  upon myself, my heirs, executors, administrators and representatives.


                PRINT Name of Participant                                  Date                          Signature of Parent/Guardian OR Participant if 18 or older


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