ACCASports Registration

A.C.C.A Multi-Sport Registration

Developing Physical Literacy & Resilience
Afro-Canadian Caribbean Association

‘Multi-sport Program’

ACCA will be offering a short 4 week (FALL) Multi-sport Program for youth to develop physical literacy through rereational sports.
- ACCA’s ‘Multi-sport’ program will be for youth (7-13 yrs) allowing them to develop physical literacy through sports. Each session focuses on developing fundamentals of athletics and sport (i.e. running, jumping, agility, balance, catching, throwing, kicking and striking objects).
Where: Benetto Elementary School
- Bennetto Elementary School, 47 Simcoe St E. Hamilton, Ontario
  (Grass Field in back of school)
When: September 20 - October 11, 2024 @ 6:00p-8:00p
- September 20 - October 11, 2024 (4 weeks)
- Friday @ Bennetto Elementary School
- Age groupings 7-9 yrs old & 10-13 Yrs old.
- If any of these programs sounds of interest to you/your child, please fill the form below, and if you have any questions or concerns, please reach out to the Youth Program Coordinator Jarek Richards.
Email: accayouthprogramcoordinator@gmail.com PH: 905-385-0925
Age*
Youth Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemaleN/AOther
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
The athlete have any chronic medical illnesses such as diabetes, asthma (exercise asthma), kidney problems, etc.?*

YesNo
Please explain
The athlete have any allergies?*

YesNoCheck box if child requires an EpiPen
Please explain
Please upload medical health document(s) (if applicable)

Cancelof
Parent/Guardian & Emergency Contact*
I, agree with the following statements:*

My Child is physically able to take part in the Sport Programs at ACCA.I know there is a risk of injury. I understand the risk of continuing to play sports with or after a concussion or other injury. my child, may have to get medical care if I have a suspected concussion or other injury. he/she also may have to wait 7 days or more and get permission from a doctor before they can start playing sports again.My Child will respect and obey all laws and the athlete's Code of Conduct at ACCASports, if not, it can lead to termination from the program.(optional) I agree to allow the ACCASports programs to use any photographic image of my child taken while participating in the program. These images may be used in promotions or other related marketing materials.I give my informed consent and permission for my child to participate in the Afro Canadian Caribbean Association ACCASports Program and its related activities.
Date*

MonthDayYear
Date
Signature (Parent/guardian)*

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A.C.C.A Multi-Sport Registration