Player Registration If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Team you are registering to * MC2 - Latinos MC3 - Foxes OT3 - Galacticos OT6 - Cuscatlan OTM2 - Los Masters Youth U7 to U18 Is the Player over 18? * YES - Please continue to "Player's Personal Information" sectionNO - Parent/Guardian must complete all next sections PLAYER'S Personal Information Player's First Name * Player's Last Name * Player's Address * City * Ottawa Gatineau Province * Ontario Quebec Postal Code * Player's Email (for confirmation purposes, not spam) * Phone (mobile preferable) * Player's Date Of Birth DOB - Day * 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 DOB - Month * Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DOB - Year * 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 Player's Gender * MaleFemale Player's OSA Registrant # Player's OHIP # Playing history ATTENTION: The “PLAYING HISTORY” section MUST be completed Any person who provides false information or withholds any of the required information will be suspended from all Ontario Soccer Association activities for one year. Has the player ever registered to play soccer in another country? * YESNO If YES, answer the following questions: a) In which country (other than Canada) did the player last register? b) With which Club did the player last register in another country? c) In which year did the player last register in another country? CONSENT FOR USE OF PERSONAL INFORMATION I authorize the Canadian Soccer Association, Ontario Soccer Association, Eastern Ontario District Association and LACA SC to collect and use personal information about me for the purpose of receiving communications from the Canadian Soccer Association, Ontario Soccer Association, District Association, League and Clubs. 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 (or my child/ward’s) membership in the Ontario Soccer Association, District Association and Club, I, the participant (parent/guardian), agree as follows: I understand that I (or 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 attached and my acknowledgement below indicates my agreement with such waiver. I am aware of The Ontario Soccer Association, EODSA, LACA SC 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 me (or my child/ward) careless, negligent and/or improper handling. Waiver and release of liability This is a binding legal agreement. As a Participant (or parent/guardian of a participant) in the programs, activities and events of the Ontario Soccer Association, their Districts, Leagues and Clubs, the undersigned acknowledges and agrees to the following terms. Disclaimer: The Ontario Soccer Association, their Districts, Leagues and Clubs, directors, officers, members, employees, coaches, volunteers, officials, participants, clubs, agents, sponsors, owners/operators of facilities, and representatives (the “Organization”) are not responsible for any injury, damage or loss of any kind suffered by the Participant during, or as a result of, any program, activity or event, caused in any manner whatsoever including, but not limited to, the negligence of the Organization. In the case of under 18 player, I believe that my child/ward is physically, emotionally and mentally able to participate in the programs, activities and events of The Ontario Soccer Association. Description of Risks: I hereby acknowledge that I am aware of the risks and hazards associated with or related to soccer. The risks and hazards of soccer include, but are not limited to injuries from: Executing strenuous and demanding physical techniques in soccer; Dryland training including weights, running, and massage; Grass, turf and other surfaces including bacterial infections and rashes; Falls to the ground due to uneven or irregular terrain or surfaces; Collisions with walls and soccer equipment; Failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment; Spinal cord injuries which may render me permanently paralyzed; Extreme weather conditions which may result in heatstroke, sunstroke or hypothermia; Contact, colliding or being struck by other participants, spectators, equipment or vehicles; Vigorous physical exertion and strenuous cardiovascular workouts; Exerting and stretching various muscle groups; and Travel to and from competitive events and associated non-competitive events which are an integral part of the organization’s activities. Furthermore, I am aware: That injuries sustained in soccer can be severe or even fatal; That I (my child/ward) may come into close contact with other participants, including the possibility of accidental and unexpected contact; That I (my child/ward) may experience anxiety while challenging myself (himself/herself) during the activities; That my (my child's/ward's) risk of injury is reduced if I (he/she) follow(s) all rules adopted during training; and That my (my child's/ward's) risk of injury increases as I (he/she) become(s) fatigued. Release of liability: In consideration of the Organization allowing me (my child/ward) to participate as a Participant, I agree: I am registering myself (my child/ward) willingly and voluntarily in these activities, events and programs; To assume all risks arising out of, associated with or related to my (my child's/ward's) participation; To be solely responsible for any injury, loss or damage that I (my child/ward) might sustain while participating; and To release the Organization from liability for any and all claims, demands, actions and costs that might arise out of my (my child/ward) participating, even though such risks, injuries, loss, damage, claims, demands, actions or costs may have been caused by the negligence of the Organization. I understand “Organization” to mean: The Ontario Soccer Association, District Associations, Leagues, Clubs 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. Who filled this form? Filled by: First Name * Filled by: Last Name * ACKNOWLEDGEMENT By acknowledging here I confirm I am (my child/ward is) the player being registered and to be bound by this Legal Agreement even if I have not read this agreement. * Confirm that you are not a bot *