ELLIOT LAKE MINOR SOCCER ASSOCIATION
2017 REGISTRATION FORM
www.elliotlakeminorsoccer.ca
Office use
Day
Player’s Name:
Player Date of Birth:
Address:
Age as of June 1st 2017:
Male ( )
Postal code:
Month
Year
or Female ( )
Phone:
Parent/Guardian 1:
Phone:
Email:
Parent/Guardian 2:
Phone:
Email:
Please fill out a form for each player you are registering. Please also provide both email contacts.
Information regarding soccer will be sent out before the start of the season.
Volunteers Are Needed. Please see our website at www.elliotlakeminorsoccer.ca for more information.
Please check any position that you would like to help with:
Coach (
)
Assistant Coach ( )
Please bring completed forms to the Ruben Yli-Juuti Centre Municipal Pool
(located behind ELSS) and make full payment to them using cash or debit
Registration Fee: $65.00 per player of any age
Cash Amount Paid:
Debit Amount Paid:
Recorded:
Payment Date:
Clerk:
Other:
Release:
I agree to release and save harmless the ELMSA, members’ clubs, coaches, employees and
volunteers from all liabilities, actions, causes for actions, claims and demands occasioned by
reason of or raising out of any injury, illness or other harm that may be incurred by the above
mentioned participant during his/her participation in or presence at any program, games or
related activities of the Association.
Participant’s Name (please print):
Parent / Legal Guardian Signature:
Please Note: By participating in soccer events you recognize and agree to the following:
- The image of you and/or your player(s) may appear in the social media of the other participants.
- The image of you and/or your player(s) may appear in pictures used by ELMSA for promotional purposes.
- Players appearing in promotional material for the ELMSA will only be named if permission is given by signing the
statement below:
I WILL ALLOW ELLIOT LAKE MINOR SOCCER TO INCLUDE THE NAME OF MY CHILD IN THE
PROMOTIONAL MATERIAL IT USES.
Signature:
www.elliotlakeminorsoccer.ca
Revision date: April 2017