Registration Form
Fill out the form carefully for registration
Attendee Name
*
First Name
Last Name
Club/Association
*
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
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10
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12
13
14
15
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17
18
19
20
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31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
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1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Please Select
Male
Female
N/A
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
I agree to Soccability Canada communicating with me on program updates. (Limited to 1 communication per month).
*
Yes
No
I agree to Soccability Canada using images and video of my participation.
*
Yes
No
Course Selection
*
Please Select
Canada Soccer Project - Saskatchewan Soccer Association
Canada Soccer Project - Tecumseh United F.C.
Canada Soccer Project - Calgary Blizzard S.C.
Canada Soccer Project - Coquitlam Metro-Ford S.C.
Canada Soccer Project - Mahone Bay S.C.
Canada Soccer Project - Digby S.A.
Canada Soccer Project - Les Cosmos
Canada Soccer Project - Langley United S.A.
Canada Soccer Project - SWEMSA
Canada Soccer Project - Bonivital S.A
-CLOSED-
Club Accessibility Program (RHSC)
Club Accessibility Program (London Whitecaps)
Club Accessibility Program (Ottawa)
Rate your experience and knowledge of disability sport in general (with 1 as a strong knowledge and 5 as no knowledge).
*
Please Select
1
2
3
4
5
Additional Comments
We value your interest in soccer for people with a disability and hope that this experience will assist you in growing the game in your community. Let us know if there is anything we can do to assist you further in this journey.
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