COERVER 10,000 TOUCH FRIDAYS APRIL 21 – AUG. 25

Please complete form below (in full) to register:

Program/Session registered for

Child’s Full Name

Address

Mother’s First/Last Name:

Cell

Email:

Emergency Information

Emergeny Contact Name:

Emergency Contact Relation To Child:

Health and Safety

Medical Concerns (ie: Allergies, health issues, and special needs)

Uniform

Shirt size

History

In which year did the player last register?

In which year did the player last register in another country?

Date of Birth - (MM-DD-YYYY)

Home Phone

Father’s First/Last Name:

Cell

Email

Emergency Contact Cell:

Illness + Physical Allergies

With which club did the player last register?

How did you hear about us?

Waiver and Consent

  1. In consideration of your participation in Future Girls Soccer as a player or any other capacity, I, the undersigned, hereby release, discharge, relinquish, give up, forego, waive and otherwise completely exonerate Future Girls Soccer, its directors, players, coaches, representatives, sponsors or others acting on behalf of Future Girls Soccer, of any liability, responsibility, culpability, or other basis upon which they may otherwise be liable for any such injury, illness, disability, incapacitation, death or other physical ailment which might arise in connection with my participation in Future Girls Soccer activities.
  2. This is intended to be a full release, waiver and relinquishment, giving up, foregoing, and discharging any and all claims or damages of any kind, character or description against Future Girls Soccer and any of its agents, directors, officials or other acting on its behalf as might arise during or as a result of my participation in the activities of Future Girls Soccer and I further specially assume all risks arising as a result of my participation in Future Girls Soccer activities.
  3. I hereby release Future Girls Soccer, its staff and sponsors, from responsibility and liability for any injury or illness that my child may sustain during this activity, knowing that reasonable precautions for the health and safety of the children will be taken.
  4. In the event of an emergency, I hereby authorize an adult leader of this event, as an agent for me, to consent to any x-ray examination; medical, dental or surgical diagnosis; treatment; and hospital care advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the province of Ontario, either at a doctor’s office or any hospital. I expect to be contacted as soon as possible. The parents/guardians are responsible for any additional expense that may result from such services.
  5. I hereby give permission to Future Girls to use photographs, social media and any other media representation of myself and my family members at the discretion of Future Girls Soccer for promotion and/or advertising. I release Future Girls, its officers, directors, volunteers and the staff from any and all responsibility/liability that may arise as a result of the use of such photos/media.
  6. This instrument is signed by me voluntarily and I will hold all parties mentioned herein and each of them free and clear from any responsibility by any reason of my participation or otherwise being involved with Future Girls Soccer and will hold each of the parties mentioned herein safe and otherwise harmless from any claims, court costs, attorneys’ fees or other expenses whatsoever caused by any suit or injury for damages brought by me or by anyone on my behalf.
  7. Refund Policy
    • For any cancellation which occurs on or before the end of the third session, all fees refunded except handling fee.
    • No refund for weather related cancellations
    • If parent or daughter is not happy for any reason a full refund minus a handling fee will always be provided.

Yes, I Accept

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