Request to Modify Registration

Players Name *

First Name Last Name

Players Birthdate *

Date

Address *

Street Address

Street Address Line 2

City Province

Postal Code

Phone Number (Cell) *

Please enter a valid phone number.

Phone Number (Home) *

Please enter a valid phone number.

Season (Year) *

ex. 2020

Indoor or Outdoor *

Indoor Outdoor Year Long

Indoor or Outdoor *

Indoor Outdoor

What program are they registered in? *

Competitive OPDL Other

Program Name *

Ex. U10B, Summer Camp, Skills Centre

Boys or Girls Program *

Boys Girls Other

Date last participated in soccer activity with team/program *

Date

Modification Requesting *

Reason for modification to registration *

Have the team staff members been made aware of the request for modification? *

Have the team staff members been made aware of the request for modification? (Competitive & High Performance Only)

Yes No

Is the player financial account with the team in good standing? (Competitive & High Performance Only)

Yes No

Ontario Soccer De-registration Form - See form to fill out below *

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Medical Note

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Parent/Guardian Signature *

Clear

Parent/Guardian Name *

First Name Last Name

Parent/Guardian Email *

example@example.com

Date of Request *

Date

Request to Modify Competitive Registration