Fergus-Elora District Soccer
P.O. Box 112, Fergus, Ontario, N1M 2W7
Phone: 519-843-3360
Email: fergussoccer@bellnet.ca
FEDS Soccer – OUTDOOR Registration Form 2016
PLEASE PRINT CLEARLY
Player Info:
[ ] Male [ ] Female
Date of Birth: DD/MM/YYYY: ___ / ___ / ___
Name:
________________________________
Home Phone: ________________ Work: ________________
Address:
________________________________
Player’s Emergency Contact Name: _________________________
Town:
________________________________
Emergency Phone No.:
Postal Code:
__________
Years of Soccer Experience _____
Division/League – House League
Under 4 - 2012 Only
Under 6 Boys - 2011, 2010
Under 6 Girls - 2011, 2010
Under 8 Boys - 2009, 2008
Under 8 Girls - 2009, 2008
NEW Under 11 Boys - 2007, 2006, 2005
NEW Under 11 Girls - 2007, 2006, 2005
U14 Mixed - 2004, 2003, 2002
U17 Mixed - 2001, 2000, 1999
Men’s - 1998 Special Needs
Fee
$160
$165
$165
$165
$165
$185
$185
$215
$220
$235
$150
[X ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
Email:
________________________________
______________________________________
Division/League - Travel
Girls U11 - 2005
Girls U12 - 2004
Girls U13 - 2003
Girls U14 - 2002
Girls U15 - 2001
Boys U9 - 2007
Boys U10 – 2006
Boys U11 - 2005
Boys U12 - 2004
Boys U13 - 2003
Boys U17
Fee
$265
$280
$285
$295
$295
$255
$260
$265
$280
$285
$320
[ X ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
Refunds & Family Discounts:
Applications for refunds must be made emailed to the FEDS office by the parent/guardian or player
No refunds will be given after the fourth week of the season, refunds before the fourth week will be reduced by the $30 insurance fee paid to SRWSA/OSA
Family Discount – 3 or more players get a $10 discount per player
Notes:
Cheques are payable to FEDS. We must charge $25.00 for NSF cheques. Any and All outstanding fees or debts must be settled prior to registration
I hereby grant Fergus Elora District Soccer the unqualified rights to take pictures (still/video) of the above players and to use them for publicity (Newspaper, TV,
etc.) and posting of said pictures on our website
Players will only play on the team that they have been assigned
I hereby release FEDS from all claims for damages arising from any accident or injury caused by or arising from participation of the player during any program
or in any facility where the program is being held
NOTICE OF WARNING: There is a potential risk in training and participation in any sport and we have tried to create a safe environment. The coach has
established rules for participation and proper conduct on or about the playing field must be followed
AGREEMENT: I have read and understand the NOTICE OF WARNING on this form. I have read and understand the registration rules. I agree to abide by the
following registration rules and also the Published Rules of the Ontario Soccer Association (South West Regional Soccer Association)
I understand as a registrant of the Ontario Soccer Association, my District Association, my League and my Club that I may receive information from time to time
related to soccer events, programs and services *
Divisions are subject to change based on registration numbers
Games will not be rescheduled due to inclement weather
By providing your e-mail address to FEDS, you are consenting to join the FEDS e-mail list, which circulates important league/club information
* [ ] Please check this box if you prefer to be excluded from receiving this information
Volunteer Positions
Name of Volunteer: _________________________________ Phone: ________________________ Email: __________________________________________
Volunteer Positions: [ ] Coach [ ] Assistant Coach [ ] Convenor Comment: _________________________________________________________________
For coaches and assistant coaches: Training is provided, police checks and interviews are mandatory as per Ontario Soccer Association
Proof of Age [ ]
All 2015/16 registrations must be accompanied by proof of age, unless provided previously for either Indoor or Outdoor registration.
CONSENT FOR USE OF PERSONAL INFORMATION
I authorize the Canadian Soccer Association, the Ontario Soccer Association, South West Regional Soccer Association and FergusElora District Soccer to collect and use personal information about my child/ward for the purpose of receiving communications from
the Canadian Soccer Association, the Ontario Soccer, District, League and Club
I understand that I may withdraw such consent related to receiving communications at any time by contacting the OSA privacy
officer at OSAPrivacyOfficer@soccer.on.ca or by mail to: Attention: OSA Privacy Officer, Ontario Soccer Association, 7601 Martin
Grove Road, Vaughan ON L4L 9E4. The Privacy Officer will advise the implications of such withdrawal.
*We do not sell or distribute your 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
parent/guardian of the player, agree as follows:
1.
2.
3.
4.
5.
6.
I understand that 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.
I have reviewed the waiver/participation agreement attached and my signature affixed hereto indicates my agreement with
such waiver/participation agreement
I am aware that the Ontario Soccer Association, South West Regional Soccer Association, Fergus Elora District Soccer and
League bylaws, policies, rules and regulations and agree to abide by them and to be bound by them.
I accept sole responsibility for my child/ward’s personal possessions and athletic equipment.
I accept all liability for any damage to the playing equipment caused by my child/ward’s careless, negligent and/or improper
handling.
TRAVEL ONLY: $50 deposit required by January 23rd , 2015.
I acknowledge that I have read this registration agreement in its entirety and that I have executed this registration agreement
voluntarily.
By signing this form, you agree that you are the parent or legal guardian of the player being registered and to be bound by this Legal
Agreement even if you have not read the agreement.
Payment [ ] Cash [ ] Cheque [ ] Credit Card
Parent/Player Name (Print): ___________________________________
Registration Fee ____________
Received by:
___________________________________
Family Discount ____________
Date:
___________________________________
Total
____________
Parent/Guardian/Player Signature: ____________________________________________________________
Receipt Given: [ ] Yes [ ] No
Date Receipt Given: ______________________
Method: [ ] Mail [ ] In Person
FEDS Authorized Signature: ______________________________________________________________
Travel Team Deposit Paid [ ]