EDMONTON & DISTRICT SOCCER ASSOCIATION
REGISTRATION FORM
Players, coaches, or managers without current EDSA identification cards must have their photo taken at the EDSA office and
produce one (1) piece of personal photo identification.
Team:
Division:
Date:
Season:
Last:
First:
Address:
City:
Home phone:
Work phone:
(check appropriate box)
Player
EDSA ID Number:
E-mail Address:
Indoor_______Outdoor__________
Initial:
Postal Code:
Coach
Birthdate:
Manager
(mm/dd/yy)
If you were last registered on a team outside the City of Edmonton, a letter of release indicating that you have no outstanding
suspensions or fines is required from your previous CSA Affiliate prior to the acceptance of this registration. If you last played with
another Association other than EDSA indicate which team (City & Province) and season last played.
Team:_________________________________ City/Province:___________________________ Country:______________________
Release of Liability, Waiver of Claims
Assumption of Risks and Indemnity Agreement
By signing this document you are waiving certain legal rights including the right to sue. Please read carefully.
I _____________________________________________________________________________________(print full name) of
_______________________________________________________________________(print full address) AM OVER THE AGE OF EIGHTEEN YEARS AND I
AGREE THAT, IN CONSIDERATION of my being permitted to enter and use any one or more of the following described lands and premises (including all
facilities and equipment located therein) for any activities including but not limited to soccer, ball hockey, box lacross, lawn (carpet) bowling, and roller
hockey located on the lands and premises being,
a. The lands and premises of the City of Edmonton municipally described as 17415 – 106A Ave which premises and leased to and operated by the
Edmonton Soccer Association;
b. The lands and premises of the City of Edmonton municipally described as 12720 – Victoria Trail which premises and leased to and operated by the
Edmonton Soccer Association;
c. The lands and premises of the City of Edmonton municipally described as 6520 Roper Road which premises and leased to and operated by the Edmonton
Soccer Association;
d. The lands and premises of the City of Edmonton municipally described as 14920 – 142 Street which premises and leased to and operated by the
Edmonton Soccer Association;
I AGREE that I, the undersigned, on behalf of myself, my heirs, successors and assignors, HEREBY REMISE, RELEASE, INDEMNIFY, DISCHAREG AND
FOREVER HOLD HARMLESS the Edmonton Soccer Association (“the Association”), the City of Edmonton (“the City”), and the association(s)/league(s)
organizing the game or event, their directors, employees, volunteers, coaches, instructors, agents and independent contractors and their heirs, successors
and assignors from any claims whatsoever arising by reason of any disease, deterioration of health, illness or injury to any person, including death, or for
damage to, or loss of any of my property resulting from or arising from use of the lands and premises, from being present on the lands and premises, from
participation in any program, from the use of any facilities or equipment located on the lands and premises, from acceptance of the advice of, or from the
negligence of the Association, the City and the association(s)/league(s) organising the game or event, their directors, employees, volunteers, coaches
instructors , agents, independent contractor or any other persons using the lands and premises.
DATED at the City of ___________________________________, in the Province of Alberta, this _______________day of __________________(month),
________________(year).
_________________________________________
COACH/MANAGER SIGNATURE
______________________________________________
PLAYER SIGNATURE
Minor Player Authorization
Must be signed by player’s Parent or Guardian. Players must be 16 years old prior to registration with EDSA. By signing, I
hereby authorize the above player to play for the above team. Minor Authorization is Valid for Current Season Only.
Date:
Phone number:
Youth Club:
Signature:
Print Name:
EIYSA ID#:
EMSA ID#:
***IMPORTANT***
1. Refer to EDSA Rules and Regulations for information regarding timelines for registering players.
2. This form must be completely filled out before ID cards can be issued.
3. WAIVERS ARE VALID FOR A 1 YEAR PERIOD FROM APRIL 1 – MARCH 31.
The EDSA is collecting this information under the authority of PIPA. This information may be shared with the ASA, ESA or the SFE for the
purpose of administering soccer programs. Participant’s names or images may be used by the EDSA for promotional purposes, including
display on the EDSA website. By signing this form, I acknowledge and accept the above term.