SKILL PROGRAM MISSISSAUGA 2010-2015

Choose one Location Choose one Location Mississauga

Full Name

Street Address

Apartment/unit

Phone Number

Email Address

Birth Date

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Choose age Choose age U12 U11 U10 U9 U8 U7

Choose 1st Session Schedule Choose 1st Session Schedule School: St. Charles Garnier Address: 4233 Central Pkwy E, Mississauga, L4Z 1M7 Day: Thursdays October: 06, 13, 20, 27. November: 03, 10, 17, 24. December: 01, 08, 15. Time: 7:00pm to 8:00pm School: St Barbara Address: 1455 Samuelson Circle, Mississauga, L5N 7Z2 Day: Friday October: 07, 14, 21, 28. November: 04, 11, 18, 25. December: 02, 09, 16. Time: 7:00pm to 8:00pm

Choose 2nd Session Schedule Choose 2nd Session Schedule School: St. Charles Garnier Address: 4233 Central Pkwy E, Mississauga, L4Z 1M7 Day: Thursdays January: 12, 19, 26. February: 02, 09, 16, 23. March: 02, 09, 23, 30 Time: 7:00pm to 8:00pm School: St Barbara Address: 1455 Samuelson Circle, Mississauga, L5N 7Z2 Day: Friday January: 13, 20, 27. February: 03, 10, 17, 24. March: 03, 10, 24, 31. Time: 7:00pm to 8:00pm

Consent for use of personal information Consent for use of personal information I authorize the First Touch FC, *Brampton, Mississauga,Barrie and Vaughan Soccer, the applicable District Association and Soccer Organization to collect and use personal information about me for the purpose of receiving communications from the Canada Soccer Association, Ontario Soccer, District Association, League and Soccer Organization. I understand that I may withdraw such consent related to receiving communications at any time by contacting the Ontario Soccer Privacy Officer at privacy@ontariosoccer.ca or by mail to: Attention: Privacy Officer, Ontario Soccer, 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 Acceptance of terms and conditions In consideration of the acceptance of my membership in Ontario Soccer, District Association and Club, I, the participant, agree as follows: I understand that I cannot coach in any sanctioned soccer game until after this registration form has been validated and the registration data has been entered in the Ontario Soccer’s computerized registration system. I have reviewed the waiver attached and my signature affixed hereto indicates my agreement with such waiver. I am aware of Ontario Soccer, District Association and Club’s 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 personal possessions and athletic equipment and accept all liability for any damage to the playing equipment caused by my careless, negligent and/or improper handling. I grant permission to the Organization to photograph and/or record my image and/or voice on still or motion picture film and/or audio tape and to use this material to promote the sport of soccer and the Organizations through the media of newsletters, websites, television, film, radio, print and/or other form. I understand I waive any claim to remuneration for use of audio/visual materials used for these purposes. By signing and dating below you agree that you are the player being registered and to be bound by this Legal Agreement even if you have not read this agreement

Parent representative name - acceptation