Youth Provincial Championship
Team Roster Form – 2016
SUBMISSION INSTRUCTIONS
 Youth Districts must submit this form, on behalf of the team, for all teams participating in Provincial Championships.
Submit in WORD FORMAT to:
Email: [email protected]
COMPETITION INFORMATION
Girls
Boys
Provincial Premier Cup
Age Category
U13
U14
TEAM INFORMATION
Provincial A Cup
U15
U16
Provincial B Cup
U17
U18
Full Team Name:
District:
Team Colours
Alternate Colours
TEAM PERSONNEL
Club:
Shorts:
Shorts:
Shirts:
Shirts:
Primary Contact Email:
Mobile Phone #:
Email:
Name of Team Manager (Primary Contact):
Primary Phone Contact #:
Name of Head Coach:
Please indicate your highest level of
certification:
Day time Phone:
Additional Staff
Name:
Additional Staff
Name:
Additional Staff
Name:
TEAM ROSTER
Jersey #
First Name
Socks:
Socks:
Soccer for Life
B Provincial
B License
A License
Mobile:
Position:
Position:
Position:
Last Name
Birthdate (mm/dd/yyyy)
DISTRICT REGISTRAR
Please sign below to confirm that all of the players listed above are registered to this team.
District Registrar Signature:
Date (mm/dd/yyyy):
COACH OR MANAGER GAME DAY CONFIRMATION
This area must be filled out to confirm the date/time of the game this roster was used for.
Name:
None
Signature:
Date (mm/dd/yyyy):
Starter? (Y/N)