Oshawa Indoor Soccer League
Individual Player Registration Form
Personal information on this form is collected pursuant to Section 11 of the Municipal Act, 2001 and
will be used as part of the registration process for teams. Questions about this collection should be
directed to the City’s Freedom of Information Coordinator at 50 Centre Street South, Oshawa,
Ontario, L1H 3Z7, by phone at 905-436-3311 or by email at [email protected].
Name:
Address:
City:
Postal Code:
Phone:
Email:
Date of Birth:
Category: ☐ Men’s ☐ Co-Ed
Division: ☐ A ☐ B
Please list the names of the individual players you would like to be placed with on a team. We cannot
guarantee placement on a team. Individual registrants will be placed on a first-come, first serve basis.
A full refunded will be provided in the event that you are not placed on a team.
Payment Information
Cash
Debit
Credit Card Number
Cheque
Amex
MasterCard
Expiry Date
Total
$
Name of Card Holder
Signature
Registration Deadline: September 14, 2016
Individual
Registration Fee
$258.20 + HST
Visa
Individual deposit due at
registration:
$129.10 + HST
Full Payment Due By: October 14, 2016
Amount Enclosed:
Date:
Submit Registration Form to: Civic Recreation Complex, 99 Thornton Rd S, Oshawa, On. L1J 5Y1
For more information call: 905-436-3311 Ext. 2749
OFN 97-0
Page 1 of 2
Acknowledgement of Risk and Waiver of Liability and Guarantee
The undersigned hereby covenants and agrees for him/herself and any other servant, agent, invitees,
guest, spectator, organization, employee, member or any other person in any way affiliated with
him/her (collectively the “Participant”) in the use of the facilities at the Civic Recreation Complex or
participation in any activity taking place at the Civic Recreation Complex, they shall be soley
responsible for all claims, demands, damages, costs, expenses, actions, causes of action, whether in
law or in equity, resulting from any personal injury, or property damage, or for the loss or theft of
clothing, equipment or personal property of the Participant, however caused, and whether contributed
to or caused by the negligence of the City of Oshawa, it’s employees, servants, officers, agents,
contractors and/or representatives and their successors and assigns (collectively the “City”).
The Participant further covenants and agrees to indemnify and save harmless the City, its employees,
servants, officers, agents, contractors and/or representatives and their successors and assigns from
and against all liability whatsoever resulting from any personal injury, property damage, loss or theft
referred to in the preceding paragraph.
The Participant acknowledges that sporting activities carry with them an inherent risk of personal
injury and/or property damage and by signing this document, the Participant acknowledges and
confirms that he/she is in good physical and/or mental health and is able to freely participate in
Oshawa Indoor Soccer League at the Civic Recreation Complex and that it is the responsibility of the
Participant and not the City, to identify any health or injury risks associated with any activities
participated in at the Civic Recreation Complex and to seek the appropriate medical advice prior to
participating.
The Participant covenants and agrees to be bound by all rules and regulations published in the
document titled Ontario Soccer Association Participation Agreement provided by the City to govern
the usage of the facility and all activities conducted thereupon.
The Participant acknowledges and agrees that the City reserves the sole and exclusive right to use
any photographs or videos taken during the program for advertising, promotional and/or instructional
purposes, without cost or charge to the City and the Participant consents to photographs or videos
being taken and used for the purposes contained herein.
The Participant further acknowledges that in consideration of being allowed to play in the Civic
Recreation Complex Oshawa Indoor Soccer League, he/she remains indebted for any amount owing
or outstanding by the individual/team to the City for the league fees.
Signature of Participant:
OFN 97-0
Date:
Page 2 of 2