For Office Use Only
ID Type Presented at time of issue: ________________
New, Renewal or Lost Card: ______________________
Player/Coach Information Form
The following groups require EMSA I.D. CARDS:
Players, Coaches, Assistant Coaches and Managers of
U16 and U18 Community
&
ALL PREMIER TEAMS
U12 & U14 Community team Coaches, Assistant Coaches and Managers will
require EMSA I.D. cards but the players do not require them.
**IDENTIFICATION MUST BE PRESENTED IN ORDER TO OBTAIN YOUR EMSA I.D. CARD
(STUDENT ID’S ARE NOT ACCEPTED)**
Team Name (eg Baturyn U14B (Smith)) _____________________________
Parent First Name: ________________________________________
Parent Last Name: ________________________________________
Parent Date of Birth: Year: _______ Month: _______ Day: ________
Player First Name: ________________________________________
Player Last Name: ________________________________________
Player Date of Birth:
Year: _______ Month: _______ Day: ________
E-Mail: _________________________________________________
Address: ________________________________________________
City:
__________________________ Postal Code: ______________
Telephone Number:
_____________ Cell Number: ______________
**Please circle the zone that you are residing in.
West
Mill Woods
Spruce Grove
South West
Sherwood Park
South East
Battleriver
North
St. Albert
Tri-County
Other: __________________
**Please CIRCLE one in each of the following:
GENDER:
Male
Female
YOUR CLASSIFICATION: Player
TEAM:
Coach
Boys
Manager
Girls
Bench