Call Now 604.440.5753

Registration Form:

* Required fields.

Player Information

Last Name (Name on Birth Certificate):
First (Name on Birth Certificate):
Birth Date:	- - (MM - DD- YY)
Address:
City:
Postal Code:
Phone Number	- -
Fax Number	- -
Sex	Male Female
Parent Email:
BC Medical Number:
Players School:
Grade in
Previous Club:
Previous Team:
Year:
Years of Playing Experience:
Level:	Gold Silver Bronze
New Player to the Club:	Yes No
Medical Alert
For players born in 2001 - 2005 we will try to place the child with one requested teammate providing the registration is received prior to June 1, 2010.
	1
	2
	3

Parent Information
Father:
Name:
Address:
Phone Number :	- -
Bus:	- -

Mother:
Name:
Address:
Phone Number :	- -
Bus:	- -

PARENT CONSENT AND INDEMNITY AGREEMENT
	I (we) agree consent to and assume all risks and hazards of, and incidental to, the participation of the above-named child in the activities of the Adlani Soccer Academy.

Volunteer Adlani Soccer Academy is a volunteer organization. Please select from the choices below

Donor:
My company will be a Corporate Sponsor:
Name:
Phone Number :	- -
Other:

Team Level: (Choose 1)
Coach:
Asst Coach:
Manager:
Other

Club Level: (Choose 2)
Chocolate Sales
Net & Flag Set Up
Field Set Up (Lining the field)
Dinner Dance / Special Events
Tournament
Website
Pictures
Other

	I Agree the application you are consenting on your behalf and on behalf of your child or children to the collection, and disclosure of your personal information for the purposes of the BC Soccer Association, the District Soccer Association and the Soccer Club. The personal information that you provide will be used for purposes reasonably associated with your child's enrolment as a soccer player. The main use of the information is to obtain insurance and for use in any necessary disciplinary proceedings. The personal information will not be disclosed to third parties other than as stipulated unless required by law.