ensure your child`s name is their birth name

PUSLINCH MINOR SOCCER CLUB
REGISTRATION CHECKLIST
TIMBITS
HAVE YOU REMEMBERED TO:
ENSURE YOUR CHILD'S NAME IS THEIR BIRTH NAME, NOT A NICKNAME or SHORTENED NAME
ENSURE YOU HAVE ENTERED YOUR EMAIL ADDRESS CORRECTLY
* EMAIL IS OUR MAIN FORM OF COMMUNICATION *
MAKE CHEQUE PAYABLE TO: PUSLINCH MINOR SOCCER CLUB (no post dates please)
PLEASE NOTE: E-MAIL $ TRANSFERS ARE ACCEPTED .. [email protected]
INCLUDE THE USER FEE:
$10.00 FOR PUSLINCH RESIDENTS
$25.00 FOR NON-PUSLINCH RESIDENTS
INCLUDE A COPY OF YOUR CHILD'S BIRTH CERTIFICATE IF NEW TO PMSC
COMPLETE THE PARTICIPATION AGREEMENT REQUIRED BY OSA
INCLUDE YOUR CHILD'S SHIRT SIZE ON THE REGISTRATION FORM
COMPLETE A SPECIAL NEEDS FORM (only if applicable - this will assist our coaches with planning)
PLEASE NOTE:
REGISTRATIONS WILL BE RETURNED IF DOCUMENTATION HAS NOT BEEN
SUBMITTED CORRECTLY OR PAYMENT HAS NOT BEEN RECEIVED IN FULL
ARE YOU INTERESTED IN BECOMING A COACH, A CO-COACH OR A TEAM MANAGER?
PLEASE SEE THE WEBSITE FOR THE COACHING REGISTRATION FORM AND RETURN WITH YOUR CHILD'S REGISTRATION
SEE WWW.PUSLINCHSOCCER.CA FOR MORE INFORMATION
PUSLINCH MINOR SOCCER CLUB
2015 TIMBITS Player Registration Form
(If this is the player’s first year with the club a copy of their birth certificate is required)
Player’s
Name:
LAST
FIRST
STREET NUMBER AND NAME
CITY
INITIAL
Address:
POSTAL CODE
HOME:
DATE OF
Phone:
BIRTH
OTHER:
YEAR
MONTH
OSA
N
UMBER
:
EMAIL:
PARENT’S NAMES:
GENDER:  FEMALE  MALE
Player Classification (Please check one): TIMBITS SOCCER OUTDOOR 2015:
Club Registration #: CD 0470
Club Name: Puslinch Minor Soccer Club
*****TOWNSHIP OF PUSLINCH USER FEES:
TIMBITS Mini :
DAY
$100.00 + user fees (Saturday only)
$120.00 + user fees (Fri. eve & Sat.)
$120.00 + user fees (Fri. eve & Sat.)
 Non Residents $25.00  Residents $10.00
Co-ed born 2009, 2010, 2011
Girls born 2007, 2008
Boys born 2007, 2008
PLAYING HISTORY
ATTENTION: The "Playing History" section MUST be completed – Any person who provides false information or
withholds any of the required information will be suspended from all Ontario Soccer Association activities for one year.
Has the player EVER registered to play soccer in another country?  Yes  NO
If Yes, answer the following questions:
a) In which country (other than Canada) did the player last register? _________________________________________________
b)
With which Club did the player last register in another country?
_________________________________________________
c)
In which year did the player last register in another country?
_________________________________________________
CONSENT FOR USE OF PERSONAL INFORMATION
I authorize the Canadian Soccer Association, the Ontario Soccer Association, SWRSA and my Club to collect and use personal
information about me or my child/ward for the purpose of receiving communications from the Ontario Soccer Association,
SWRSA, League and Club.
I understand that I may withdraw such consent related to receiving communications at any time by contacting the OSA Privacy
Officer at [email protected] or by mail to: Attention: OSA Privacy Officer, Ontario Soccer Association,
7601 Martin Grove Road, Vaughan ON L4L 9E4. The Privacy Officer will advise the implications of such withdrawal.
*We do not sell or distribute your personal information to any other third party not listed herein.
ACCEPTANCE OF TERMS AND CONDITIONS
In consideration of the acceptance of my or my child/ward’s membership in the Ontario Soccer Association, District Association and Club, I, the
participant and parent/guardian (if participant is under 18 years of age), agree as follows:
1.
I understand that I or my child/ward cannot play in any sanctioned soccer game until after this registration form has been validated and the
registration data has been entered in The Ontario Soccer Association's computerized registration system.
2. I have reviewed the waiver/participation agreement attached and my signature affixed hereto indicates my agreement with such
waiver/participation agreement.
3. I am aware of The Ontario Soccer Association, The South-West Regional Soccer Association, Puslinch Minor Soccer Club and League
bylaws, policies, rules and regulations and agree to abide by them and to be bound by them.
4. I accept sole responsibility for my or my child/ward’s personal possessions and athletic equipment.
5. I accept all liability for any damage to the playing equipment caused by me or my child/ward’s careless, negligent and/or improper handling.
I acknowledge that I have read this registration agreement in its entirety and that I have executed this registration agreement voluntarily.
_________________________________
__________________________________
_________________
Signature of Participant (If aged18 and over)
Signature of Parent/Guardian (If under 18)
Date
For Use by Club Registrar
Verification
of Birth Date
Birth Certificate
Note: Club must retain a copy of the player registration
form and, if requested, must submit form to SWRSA or
the Ontario Soccer Association upon request.
Player Book
Other
Registrar's Signature
TOTAL PAID: _________Cash __________ Chq # _____
Date
___
Name on Chq ________________________________
ONTARIO SOCCER ASSOCIATION: PARTICIPATION AGREEMENT
(1 COPY PER PLAYER)
FOR THOSE UNDER 18 YRS
By signing this document you will waive certain legal rights, PLEASE READ CAREFULLY.
Name of Player: _______________________________________
Age _ _ __
Date of Birth ____________
(year/month/day)
IN CONSIDERATION of allowing my minor child/ward to participate in the programs, activities and events of The Ontario Soccer
Association,
I ASSURE TO YOU THAT:
1.
I am the parent/guardian of the above named participant having full legal responsibility for decisions regarding the above named
participant.
2.
I believe that my minor/ward is physically, emotionally and mentally able to participate in the programs, activities and events of The
Ontario Soccer Association.
3.
I hereby acknowledge that I am aware of the risks and hazards associated with or related to soccer. The risks and hazards include,
but are not limited to injuries from:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
4.
Executing strenuous and demanding physical techniques in soccer;
Dry land training including weights, running and massage;
Grass, turf and other surfaces including bacterial infections and rashes;
Falls to the ground due to uneven or irregular terrain or surfaces;
Collisions with walls and soccer equipment;
Failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment;
Extreme weather conditions which may result in heatstroke, sunstroke or hypothermia;
Contact, colliding or being struck by other participants, spectators, equipment or vehicles;
Vigorous physical exertion and strenuous cardiovascular workouts;
Exerting and stretching various muscle groups; and
Travel to and from competitive events and associated non-competitive events which are an integral part of the organization’s
activities.
Furthermore, I am aware that my child/ward may:
a.
b.
c.
d.
e.
Sustain injuries in soccer that can be severe, cause spinal cord injuries and even be fatal;
Experience anxiety while challenging himself/herself during the activities, events and programs;
Come into close contact with other participants, including the possibility of accidental and unexpected contact;
Risk of injury is reduced if he/she follows all rules established for participation; and
Risk of injury increases as he/she become fatigued.
I UNDERSTAND AND AGREE, on behalf of myself, my heirs, assigns, personal representatives and next of kin that my signing of this
document constitutes:
5.
I am registering my child/ward willingly and my child/ward is participating voluntarily in these activities, events and programs.
6.
I agree that there are risks in soccer as described above and my child/ward will be exposed to these risks and hazards.
7.
I agree to accept all these risks and hazards and be responsible for any injury or other loss which my minor child/ward might receive
while participating in these events, activities and programs.
8.
If something happens to my child/ward, I release the Organizers of responsibility for any claims, demands, actions and costs which
might arise out of my child/ward’s participation. I understand “Organizers” to mean: The Ontario Soccer Association, District
Associations, Leagues, Clubs and their directors, officers, members, employees, volunteers, officials, participants, clubs, agents,
sponsors, owners/operators of facilities, and representatives.
Accident Insurance
Executing this agreement will not preclude you from accident insurance coverage, subject to the terms and conditions of The Ontario
Soccer Association’s insurance policy.
I ACKNOWLEDGE MAKING THIS AGREEMENT
I have read and understood the terms and conditions of this agreement, and by signing it voluntarily, I am agreeing to abide by these
terms.
_________________________________
Printed Name of Parent or Guardian
_________________________
Signature of Parent or Guardian
__________________
Date
Active Participant Special Needs Form
Participant Last Name:
Participant First Name:
Participant Age:
Activity or Sport:
Registrars Name:
Date Form Completed:
Special Needs Type: (check all applicable boxes)
Physical - 
Other - 
Developmental -

Dietary -
Participant
Sex:
Allergies:

Emergency Contact Name:
Emergency Contact Number:
If Required, Physicians Name:
Physicians Contact Number:
Briefly Describe Special Needs and Any Required Actions:
(ex. Participant Allergic to Bee Stings – Participant carries EpiPen)
Player Pledge: I will participate because I want to, not because my parents or coaches want me to. I will honour the Spirit of the Game, respecting ROOTS (Rules, Opponents, Officials, Teammates and Self). I will control my temper. I will acknowledge all good plays – those of my team and my opponents. I will remember that coaches and officials are there to help me. I will accept their decisions and show them respect. I will do my best to be a true Team Player. I will give 100% effort. I will do my best to be on time and to attend all practices and games. I will leave my electronics in my bag while at the soccer field. If I need to use it for a ride, I will do so after the practice or game is done. I will not post anything derogatory on Social Media of any kind. I will not post information, photos, or other representations of sexual content, inappropriate behaviour (e.g. drug or alcohol use), or items that could be interpreted as demeaning or inflammatory. I will adhere to the dress code set out by the coaches for my team. For insurance reasons, all players must wear shin guards to all practices and games. If I do not have them, I will not be allowed to play. Player’s Name: Player’s Signature: Parent Pledge: I will not force my child to participate in soccer. I will remember that my child plays soccer for his/her own enjoyment, not mine. I will remember that children learn best by example. I will set an example for my child by honouring the Spirit of the Game, respecting ROOTS (Rules, Opponents, Officials, Teammates and Self). I will applaud good plays/performance by both my child’s team and their opponents. If I disagree with an official’s call, I will Honor the Game and be silent. I will encourage my child to play by the rules and to resolve conflicts without resorting to hostility or violence. I will refrain from negative comments about my child’s coach in my child’s presence so that I do not negatively influence my child’s motivation and overall experience. I will be as prompt as possible dropping my child off and picking my child up from practices and games. I will respect and show appreciation for the volunteer coaches who give their time to provide soccer to my child. I understand that the referee has the right to ask me to leave the field if I am disrespectful. Foul language will not be tolerated at any practice or game. Parent’s Name: Parent’s Signature: Created from CanadaSoccer: Fair Play Codes and Positive Coaching Alliance Parent Pledge (positivecoach.org). Coaches Application
Part 1: Personal Information (put answers in grey boxes)
First Name
Last Name
E-mail
Home Number
Cell Number
Part 2: Team you are applying to coach next season
Gender
Male
Female
Team will play in which age group next season (eg. U12)
Level?
Timbits
ESL
2015
SWRSL
Are you willing to consider co-coaching?
Yes
No
If you already plan on co-coaching, who do you plan to do this with?
Occasionally, candidates are required to come to an interview or run a practice. Are you OK with
this?
Yes
No
Part 3: Team you coached last season
Did you coach a team last season?
Yes
No
Which club did you coach at last season?
Which gender, age and level?
Part 4: Your playing and/or coaching background
Please check the OSA coaching courses you have completed
NCCP#:______________
Senior Community
Active Start
FUNdamentals
Learn to Train
Soccer for Life
Respect in Soccer
Making Ethical Decisions
If you have coaching certification outside of OSA, please describe:
Have you coached age groups other than what you are applying for? If yes, please describle:
Describe your playing experience (youth and/or adult):
Please email completed application to [email protected]. PUSLINCH MINOR SOCCER CLUB
Coaching Staff Registration Form (18 & Over)
 Head Coach
 Assistant Coach
 Team Manager
2015
Please complete both sides of this form.
COACH CONTACT INFORMATION
Full Name:
Last
First
M.I.
Address:
Street Address
Apartment/Unit #
City
Province
Home Phone:
Cell
Number:
Postal Code
Business Phone:
E-mail Address:
COACH INFORMATION
Birth Date:
year
(y/m/d)
month
day
Gender:
OSA Registrant #
M
F
TEAM DETAILS
Club Name:
Puslinch Minor Soccer Club 0470
League Name:
Team Name:
Puslinch Predators
Division Name:
I NDOOR : __ Mini Indoor ___ Youth Indoor ___ Senior Indoor ___ Pro Indoor
__ Mini Futsal ___ Youth Futsal ___ Senior Futsal ___ Pro Futsal
O UTDOOR : ___ Mini Outdoor ___ Youth Competitive ___ Youth Recreational ___ Senior Competitive ___ Senior Recreational ___ Pro Outdoor
CONSENT FOR USE OF PERSONAL INFORMATION
I authorize the Canadian Soccer Association, Ontario Soccer Association, SWRSA and SWRSL/ESL/NPHSL as applicable, and
Puslinch Minor Soccer Club to collect and use personal information about me for the purpose of receiving communications from the
Canadian Soccer Association, Ontario Soccer Association, District Association, League and Club.
I understand that I may withdraw such consent related to receiving communications at any time by contacting the OSA Privacy Officer
at [email protected] or by mail to: Attention: OSA Privacy Officer, Ontario Soccer Association, 7601 Martin
Grove Road, Vaughan ON L4L 9E4. The Privacy Officer will advise the implications of such withdrawal.
*We do not sell or distribute your personal information to any other third party not listed herein.*
ACCEPTANCE OF TERMS AND CONDITIONS
In consideration of the acceptance of my membership in the Ontario Soccer Association, District Association and Club, I, the
participant agree as follows:
1.
2.
3.
4.
5.
I understand that I cannot coach in any sanctioned soccer game until after this registration form has been validated and the
registration data has been entered in The Ontario Soccer Association's computerized registration system.
I have reviewed the waiver attached and my signature affixed hereto indicates my agreement with such waiver
I am aware of The Ontario Soccer Association, SWRSA, Puslinch Minor Soccer Club and League bylaws, policies, rules and
regulations and agree to abide by them and to be bound by them.
I accept sole responsibility for my possessions and athletic equipment.
I accept all liability for any damage to the coaching equipment caused by me or my careless, negligent and/or improper handling.
By signing and dating below you agree that you are the coach being registered and to be bound by this Legal Agreement even if you
have not read this agreement.
______________________________________________
Signature of Coach
_____________________
Date
For use by CLUB REGISTRAR
For use by District Association
SIGNATURE___________________________
SIGNATURE___________________________
Date ____________________
Date ____________________
Note: All Youth Clubs must retain copy of each Coach Registration form. All senior clubs must submit each form
to its District Association and if requested must submit a copy to the Ontario Soccer Association.
ONTARIO SOCCER ASSOCIATION
WAIVER AND RELEASE OF LIABILITY
(To be signed by Coaches 18 yrs of age and older)
By signing this form you give up important legal rights. Please read carefully!
1. This is a binding legal agreement. As a Participant in the programs, activities and events of the Ontario Soccer
Association, their Districts, Leagues and Clubs, the undersigned acknowledges and agrees to the following terms.
Disclaimer
2. The Ontario Soccer Association, their Districts, Leagues and Clubs, directors, officers, members, employees, coaches,
volunteers, officials, participants, clubs, agents, sponsors, owners/operators of facilities, and representatives (the
“Organization”) are not responsible for any injury, damage or loss of any kind suffered by a Participant during, or as a
result of, any program, activity or event, caused in any manner whatsoever including, but not limited to, the negligence
of the Organization.
Description of Risks
3. In consideration of my participation as a Participant in such programs, activities and events, I hereby acknowledge that I
am aware of the risks and hazards associated with or related to soccer. The risks and hazards of soccer include, but are
not limited to injuries from:
• Executing strenuous and demanding physical techniques in soccer;
• Dryland training including weights, running, and massage;
• Grass, turf and other surfaces including bacterial infections and rashes;
• Falls to the ground due to uneven or irregular terrain or surfaces;
• Collisions with walls and soccer equipment;
• Failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment;
• Spinal cord injuries which may render me permanently paralyzed;
• Extreme weather conditions which may result in heatstroke, sunstroke or hypothermia;
• Contact, colliding or being struck by other participants, spectators, equipment or vehicles;
• Vigorous physical exertion and strenuous cardiovascular workouts;
• Exerting and stretching various muscle groups; and
• Travel to and from competitive events and associated non-competitive events which are an integral part of the
organization’s activities.
4. Furthermore, I am aware:
• That injuries sustained in soccer can be severe;
• That I may come into close contact with other participants, including the possibility of accidental and unexpected
contact;
• That I may experience anxiety while challenging myself during the activities;
• That my risk of injury is reduced if I follow all rules adopted during training; and
• That my risk of injury increases as I become fatigued.
Release of Liability
5. In consideration of the Organization allowing me to participate as a Participant, I agree:
a) To assume all risks arising out of, associated with or related to my participation;
b) To be solely responsible for any injury, loss or damage that I might sustain while participating; and
c) To release the Organization from liability for any and all claims, demands, actions and costs that might arise out of
my participating, even though such risks, injuries, loss, damage, claims, demands, actions or costs may have been
caused by the negligence of the Organization.
Accident Insurance
Executing this agreement will not preclude you from accident insurance coverage, subject to the terms and conditions of
The Ontario Soccer Association’s insurance policy.
Acknowledgement
By signing and dating below you agree that you are the coach being registered and to be bound by this Legal Agreement
even if you have not read this agreement.
____________________________________
Name
___________________________________
Signature
_____________________
Date