Semi-Private HP Registration Form

ASANTE SOCCER ACADEMY

415 Oakdale Road, North York, ON, M3N 1W7

r.asante@asanteacademy.com

www.asanteacademy.com

(647) 881 9179
Asante High Performance Semi-Private Registration Form

INDOOR
These semi-private sessions are limited to 15 players and take place on Tuesdays from 5pm to 6pm at GTA Sportsplex (8301 Keele St).
PLAYER INFORMATION:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
PARENT INFORMATION:
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
emergency contact:
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship to Player*
MEDICAL INFORMATION:
Does the player have any allergies, chronic illness, or medical conditions?*

YesNo
Please describe*
waiver for participation:
I hereby register my child and I do understand that there is a potential for injury while participating in the programs offered by this club and I agree to hold harmless Asante Soccer Academy (ASA), the team, the officials, the league, or District Associations from any and all injuries sustained while playing for ASA at practice, games, or events.*

I agree
I agree to supply my child with soccer shoes and shin pads to be worn at all times during play and practices.*

I agree
I agree to abide by the rules and regulations of Asante Soccer Academy, the Ontario Soccer Association, and the North York Soccer Association.*

I agree
I consent to my child being publicized, filmed, audio taped, photographed, interviewed by employees, agents, or servants of ASA.*

I agree
CONFIRMATION:

By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
Parent Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
PAYMENT

The player cannot attend any sessions payment has been received. Each new registration comes with a High Performance shirt.
Please Select Shirt Size*
Cancellations must be made at least 24 hours in advance or the missed session will count towards your package.

My Products

Part 1October 3 - December 19

$675.00CAD

Part 2January 9 - April 16

$675.00CAD

Enter coupon

Total

$0.00CAD

Credit Card

Should be Empty:

Asante High Performance Semi-Private Registration Form

PLAYER INFORMATION:

PARENT INFORMATION:

emergency contact:

MEDICAL INFORMATION:

waiver for participation:

CONFIRMATION:

PAYMENT

Credit Card