PCFC Fall/Winter Soccer Registration Form

PCFC Fall/Winter Soccer Registration
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
E-mail*
example@example.com
REGISTRATION WAIVER
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Pictou County FC. In exchange for the acceptance of said child’s registration by Pictou County FC, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Pictou County FC and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected soccer sessions.

In case of injury to said child, I hereby waive all claims against Pictou County FC, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including soccer. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Signature

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Total

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Payment

You can send your registration fees via e-transfer to: Aseriesfootball@outlook.com. No security question required as it will be auto-deposited. All fees must be paid by Sept 16, 2025, unless special arrangements are made - please contact our customer service email to schedule payment (customerservice@pictoucountysoccer.com).
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PCFC Fall/Winter Soccer Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

REGISTRATION WAIVER

Payment