Quinndale Community Council Youth Soccer 2012 Registration

Player Information

First Name: ____________________________ Last Name:____________________________________

Date of Birth: Day _____ Month _________Year_________ (1st time Players registering are required to show an original birth certificate)

Home Address: ______________________________________________________________________

City: _______________________ Postal Code:________________ Phone:________________________

Male_______ / Female_______ Has your child played before: Yes______ No______ How many years_____

Parent / Guardian Information

Name: ___________________________________Phone:____________________ Cell: ___________________

Name: ___________________________________ Phone: ___________________ Cell:___________________

Email: ____________________________________________________________________________________

Without volunteers this program can not run. Please consider one of the following positions:

Coach___ Assistant Coach___ Referee (paid position) ___Council___ League/Team Sponsor___ Volunteer___

Parent/Guardian Agreement -Please Read

I hereby acknowledge that Quinndale Community Council will not be held responsible for any injury, losses, or damages that may occur while participating in the sport program. I also acknowledge that the uniform remains the property of the Council until the end of the season. In the course of this activity that is open to the public, photographs or other recordings may be taken or made of the player to whom this registration form pertains. I give approval thereto including, but not limited to, the placing of photographs of the player to whom this registration pertains on the Club’s website. I hereby assign and transfer to the Quinndale Community Council any rights, including any copyright that the player to whom this registration form pertains may have in any such material so produced.

Upon receipt of NSF check by the league player’s registration is void until cash payment is made, including all bank fees.
Quinndale Community Council will strictly enforce the City of Hamilton’s Zero Tolerance Policy. Any person including: spectator, parent, coach, player or referee can be asked to leave the park at the discretion of a Quinndale Council member.
Quinndale reserves the right to move players (with or without player request) as part of the league equalization process.

I have read, understand and agree to all of the terms and provisions of the Quinndale Community Council Soccer Registration

Parent/Guardian Signature: ________________________________ Date:_________________

2012 Season Fee: $85 for Junior - all other divisions $110.00 Payment by Cheque only please. Do not send cash through the mail.

Division: Junior (born 2006-2007) _____ Inter 1 (born 2004-2005) _____ Inter 2 (born 2002-2003) _____

Senior 1 (born 2000-2001) _____ Senior 2 (born 1998-1999) _____ Senior 3 (born 1996-1997) _____

Senior 4 (boys born 1994-1995, girls born 1991-1995)

Q.C.C. Rep. Signature: ___________________________________ Form # ___________________

Tax receipts will only be issued after cheques are cashed