SOUTH-WEST REGIONAL SOCCER ASSOCIATION
44 Beasley Drive Kitchener ON N2E 1Y6
Phone: 519-894-5965
Email: [email protected] Web: www.swrsa.ca
LOCAL LEAGUE: Blanket Team PLAYING-OUT Application
This application must be received by March 24th to be considered.
If approved, validated team rosters must be received by the third Friday of April.
There is a $100 levy for any late team applications.
Instructions:
1. All communications by SWRSA regarding this application will be addressed to your club.
2. Incomplete applications will be returned.
3. This application covers all teams entered by one club into a Local League in another District.
4. Clubs with teams participating is multiple leagues are required to complete separate applications for each
League.
DATE OF APPLICATION: __________________________________
1. Club Information:
Club Name:
Club Number: CD 04 __ __
Email:
Phone (Day):
2. League Information:
League Name:
Please circle the District where your team(s) will play:
Boys’ Teams Divisions
Number of teams
U10
Age
U12
Division(s)
U14
U16
OTHER:
EMSA PHSA Hamilton Huronia Other
Girls’ Teams Divisions
Number of teams
U10
U12
U14
U16
OTHER:
3. Club Approval:
Club President: This Section must be signed by the Club President only.
_____________________________________________________
Club Position: PRESIDENT
PRINT NAME
Phone:
_____________________________________________________
SIGNATURE
FOR DISTRICT OFFICE USE ONLY
Application:
□ Approved
District Official’s Validation Date:
District Official’s Signature:
□ Denied
Email:
Date received by SWRSA
Date processed by SWRSA