Edmonton & District Soccer Association

EDMONTON & DISTRICT SOCCER ASSOCIATION

REGISTRATION FORM

Players, coaches, or managers without current EDSA identification cards must have their photo taken at the EDSA office and produce one (1) piece of personal photo identification.

Team: / Date:
Division: / Season: Indoor______Outdoor______
Last: First: Initial:
Address: City: Postal Code:
Home phone: Work phone:
(check appropriate box) Player Coach Manager Attendant
EDSA ID Number: Birth Date: (mm/dd/yy)
E-mail Address: LAST TEAM:
If you were last registered on a team outside the City of Edmonton, a letter of release indicating that you have no outstanding suspensions or fines is required from your previous CSA Affiliate prior to the acceptance of this registration. If you last played with another Association other than EDSA indicate which team (City & Province) and season last played.
Team:______City/Province:______Country:______

Release of Liability, Waiver of Claims

Assumption of Risks and Indemnity Agreement

By signing this document you are waiving certain legal rights including the right to sue. Please read carefully.

I ______(print full name) of

______(print full address) AM OVER THE AGE OF EIGHTEEN YEARS AND I AGREE THAT, IN CONSIDERATION of my being permitted to enter and use any one or more of the following described lands and premises (including all facilities and equipment located therein) for any activities including but not limited to soccer, ball hockey, box lacross, lawn (carpet) bowling, and roller hockey located on the lands and premises being,

a. The lands and premises of the City of Edmonton municipally described as 17415 – 106A Ave which premises and leased to and operated by the Edmonton Soccer Association;

b. The lands and premises of the City of Edmonton municipally described as 12720 – VictoriaTrail which premises and leased to andoperated by the Edmonton Soccer Association;

c. The lands and premises of the City of Edmonton municipally described as 6520 Roper Road which premises and leased to and operated by the Edmonton Soccer Association;

d. The lands and premises of the City of Edmonton municipally described as 14920 – 142 Street which premises and leased to andoperated by the Edmonton Soccer Association;

I AGREE that I, the undersigned, on behalf of myself, my heirs, successors and assignors, HEREBY REMISE, RELEASE, INDEMNIFY, DISCHAREG AND FOREVER HOLD HARMLESS the Edmonton Soccer Association (“the Association”), the City of Edmonton (“the City”), and the association(s)/league(s) organizing the game or event, their directors, employees, volunteers, coaches, instructors, agents and independent contractors and their heirs, successors and assignors from any claims whatsoever arising by reason of any disease, deterioration of health, illness or injury to any person, including death, or for damage to, or loss of any of my property resulting from or arising from use of the lands and premises, from being present on the lands and premises, from participation in any program, from the use of any facilities or equipment located on the lands and premises, from acceptance of the advice of, or from the negligence of the Association, the City and the association(s)/league(s) organising the game or event, their directors, employees, volunteers, coaches instructors , agents, independent contractor or any other persons using the lands and premises.

DATED at the City of ______, in the Province of Alberta, this ______day of ______(month), ______(year).

______

COACH/MANAGER SIGNATURE PLAYER (PARENT SIGNATURE IF MINOR)

Minor Player Authorization

Must be signed by player’s Parent or Guardian. By signing, I hereby authorize the above player to play for the above team. Minor Authorization is Valid for Current Season Only.

Youth Club: / EIYSA ID#: EMSA ID#:
Phone number: / Print Name:
Date: / EDSA Signature:

***IMPORTANT***

1. Refer to EDSA Rules and Regulations for information regarding timelines for registering players.

2. WAIVERS MUST BE COMPLETED FOR EACH SEASON.

The EDSA is collecting this information under the authority of PIPA. This information may be shared with the ASA, ESA or the SFE for the purpose of administering soccer programs. Participant’s names or images may be used by the EDSA for promotional purposes, including display on the EDSA website. By signing this form, I acknowledge and accept the above term.