Registration Form - Spartans Soccer Club & Academy

Player's First Name*

Player's Last Name(s)*

Player’s Date of Birth*

Player’s Date of Birth

Gender*

Phone Number*

E-mail*

Address*

Parent/Guardians Information

Parent/Guardian's First Name*

Parent/Guardian's Last Name*

Email*

Relationship To Player (Father, Mother, Uncle, Aunt, etc)*

Parent's Address (if different from that of player)

Parent/Guardian's Phone Number*

I consent to my child’s participation in activity with Spartans Soccer Academy and Club (SSCA). I am aware that there are risks associated with participation in moderate activities, including the risk of injury, and I consent to my child’s participation in spite of such risks. I acknowledge that it is my responsibility to advise SSCA of any medical condition that my child may have that may prevent them from participating in any of the various activities. In the event that my child requires medical attention, I consent to my child being transported to the nearest emergency centre, including by ambulance if necessary, and accept that I am responsible for any costs of such ambulance services.

Emergency Contact Information

Emergency Contacts First Name*

Emergency Contacts Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relationship to Player*

Does Your Child Have Any Allergies

Yes
No

Child's Allergies

Does Your Child Have Any Other Medical Conditions We should know about?

Yes
No

Child's Medical Condition

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