Outdoor MK Registration Form 2025

ASANTE SOCCER ACADEMY

415 Oakdale Road, North York, ON

M3N 1W7

info@asanteacademy.com

www.asanteacademy.com

(647) 881 9179
MINI KICKERS REGISTRATION FORM

OUTDOOR
PROGRAM DETAILS

Saturday at Beverly Heights Middle School (26 Troutbrooke Dr) from 10:00 am to 11:00 am.

Includes one game jersey, ONE SHORTS AND I PAIR OF SOCKS
Player information:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Age*
PARENT information:
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
EMERGENCY CONTACT:
Full Name*

First NameLast Name
Phone Number*
Relationship to Player
medical information:
Does the player have any allergies, chronic illness, or medical conditions?*

YesNo
Please describe*
Player Health Card Number*
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

My Products*

Summer Mini Kickers Registration

$225.00CAD

Enter coupon

Total

$0.00CAD

Credit Card

PAYMENT
Should be Empty:

MINI KICKERS REGISTRATION FORM

PROGRAM DETAILS

Player information:

PARENT information:

EMERGENCY CONTACT:

medical information:

Waiver for participation:

Credit Card

PAYMENT