ClubReg

Markham Soccer Club

Indoor 2010 - 2011

MIXED YOUTH HOUSE LEAGUE
Teams Include Boys and Girls

Player Registration

Registration Fees

Birth Year	# Nights	Fee
1993 - 2006	1	240

No refund for any reason after Oct 1, 2010
(except for wait-listed players). Registration fees cannot be transferred to Skills Clinics after Sept 30.

NSF Cheques/Chargebacks

$40

Cancellation

$35

NOTE: There is a $5.00 handling charge included in the registration fees.

Refunds can only be processed if the cancellation is received in writing by the Club prior to Oct 1, 2010.

This registration can only be processed if:

This form is completed in full and elctronically "signed";

An online payment is made for the correct amount.

Proof of age is provided for any players new to this club (a copy of a birth certificate or other proof of age can be dropped at the club or mailed).

Preference to Town of Markham residents until Sep 17, 2010. Others put on a reserve list then assignd after that date based on available space. This is a private club. This application may be accepted or not accepted at the discretion of the Board of Directors.

We do not accept special requests.

PLAYER INFORMATION

Hint: You can use the tab key to move from field-to-field (you don't need to use the mouse for most things).

	First Name	Last Name	Male Female


	Street	Apt


	Town / City	Postal Cd	dd mm yy birth day


	Home Phone	Business Phone	Cell Phone

		Yes No
	Email Address - Parent/Guardian/ Player 18+	Has this player registered with this club in a previous season?

Last Soccer Registration

Ever Registered Outside Canada (if so fill in the three fields below)?

Year

Club

Year

Country

Club

VOLUNTEER & SPONSOR INFORMATION

As a volunteer organization, we need your help.


	Volunteer Name(s) / Sponsor Contact & Company Name	dd mm yy	Coach level
		birth date (coaches & asst coaches)

	Position
	Coach Asst Coach Convenor Sponsor Other Vol Position

PRIVACY

I authorize the Markham Soccer Club and its Governing Bodies to collect and use personal information about me or my child/ward for the purpose of communication; and the disclosure of my or my child/ward�s name and address to the Town of Markham for the purpose of securing fields. We do not sell your personal information to any third parties. This information is disclosed to those who have a need to use that information to support the operation of the Club. If you wish to be excluded from receiving communications from the Club�s Governing Bodies, please check the box.
Check here to be excluded

AGREEMENT & DISCLAIMER

You must be 18 years or older in order to (electronically) sign this agreement. A parent or guardian must sign for a minor. If this form is being filled out on behalf of a minor, please complete the three boxes below.

Name of person submitting and signing this form (first & last)
Relationship to the applicant (must be: Mother, Father or Legal Guardian)

I agree to participate (or to allow this child to participate, if signing on behalf of a minor) in the activities of the Markham Soccer Club. I understand and accept that there is a potential risk in training and participating in any sport; and, that the club tries to create a safe environment. I agree not to hold the Markham Soccer Club, its Directors or other club volunteers liable for any damages; loss; or injury sustained by this child and/or by me as a consequence of his/her/my participation in; or presence at: any programs, games or other activities of the Markham Soccer Club and I hereby release them from such claims.

I agree on my behalf (and on behalf of this child if signing for a minor) and on behalf of any other family members who may attend practices, games or club events to abide by the rules, policies and decisions of the Markham Soccer Club and its governing bodies (YRSA, OSA, CSA, FIFA). The Club has established rules for participation. Proper conduct on and about the field must be followed. I understand that a player may be removed from a league/team if more than three games are missed without an acceptable reason; or, if the continued participation by this player will result in safety concerns or otherwise adversely affect the enjoyment of the game by other players on the team / in that league.

I specifically grant permission to the Markham Soccer Club to use my/my child's likeness, voice and words in television, radio, film, newsletters, magazines, and other media; and, in any form not heretofore described, for the purpose of advertising or communicating activities of the Markham Soccer Club.

Participant Agreement - Please review the Participant Agreement below.
Your electronic signature below includes your agreement to the content of this Participant Agreement on behalf of your child.

PARTICIPATION AGREEMENT FOR THOSE UNDER 18 YRS
By signing this document you will waive certain legal rights.
PLEASE READ CAREFULLY.

IN CONSIDERATION of allowing my minor child/ward to participate in the programs, activities and events of The Markham Soccer Club,

I ASSURE TO YOU THAT:
1.	I am the parent/guardian of the registrant named in the registration form on the reverse of this page, and I have full legal responsibility for decisions regarding this registrant. 
2.	I believe that my minor/ward is physically, emotionally and mentally able to participate in the programs, activities and events of the Markham Soccer Club.
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 massage;
 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 associated non-competitive events that 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 follows 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:
1.	I am registering my child/ward willingly and my child/ward is participating voluntarily in these activities, events and programs.  
2.	I agree that there are risks in soccer as described above and my child/ward will be exposed to these risks and hazards.
3.	I agree to accept all these risks and hazards and be responsible for any injury or other loss that my minor child/ward might receive while participating in these events, activities and programs.
4.	If something happens to my child/ward, I release the organizers of responsibility for any claims, demands, actions and costs that might arise out of my child/ward's participation.  I understand "Organizers" to mean: The Markham Soccer Club, its Governing organizations, Leagues, other Clubs and Districts and their directors, officers, members, employees, volunteers, officials, participants, clubs, agents, sponsors, owners/operators of facilities, and representatives.

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.

I understand that by electronically signing the Registration Form, I am agreeing to this Participation Agreement in its entirety.

I hereby certify that all of the information that I have provided on this form is accurate and complete. I have read and understood; and, I accept all of the terms and conditions that are stipulated in this registration document. I understand that clicking on the button on the left constitutes an electronic signature and legally binds me in the same manner as signing a registration form.

Version - Jan 10, 2010