Blue Wings Soccer Registration Form

Blue Wings Soccer

Please fill out your details to complete the registration process.
Participant Information
Participant Name

First NameLast Name
Date of Birth

MonthDayYear
Age
Gender
Parent/Guardian Name

First NameLast Name
Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Email Address
Program Registered

Medical Information
Family Doctor
Doctor Phone Number
Format: (000) 000-0000.
OHIP Number (Optional)
Allergies
Medical Conditions
Medications
Emergency Contact Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.

MEDICAL EMERGENCY AUTHORIZATION
In the event of an accident, injury, or medical emergency, and if a parent/guardian cannot be reached immediately, I authorize Blue Wings Soccer staff or volunteers to seek emergency medical treatment for my child.
Agreement
WAIVER AND RELEASE OF LIABILITY
I understand that participation in soccer activities involves inherent risks, including but not limited to:
• Falls and collisions
• Contact with other participants
• Sprains, strains, fractures, and other injuries
• Weather-related conditions
• Risks associated with running, jumping, kicking, and physical activity
I voluntarily permit my child to participate in Blue Wings Soccer activities and accept all risks associated with participation.
In consideration of participation, I release and discharge Blue Wings Soccer, its directors, coaches, volunteers, assistants, and representatives from any liability, claims, demands, actions, damages, costs, or expenses arising from injury, illness, loss, or damage related to participation in any soccer activity, except where prohibited by law.
Agreement
CONCUSSION ACKNOWLEDGEMENT
(Rowan's Law Compliance)
I understand that soccer is a sport in which concussions may occur.
I acknowledge that:
• A participant suspected of having sustained a concussion will be immediately removed from training or play.
• The participant will not return to soccer activities on the same day.
• Medical evaluation may be required.
• The participant may only return to soccer activities after receiving appropriate medical clearance and following a graduated return-to-sport protocol.
I agree to immediately report any suspected concussion symptoms to the coach or program staff.
Agreement
PHOTO & VIDEO CONSENT SELECTION
Blue Wings Soccer may occasionally take photographs or videos during training sessions, camps, or events.
These images may be used for:
• Program promotion
• Social media
• Website content
• Educational and community outreach materials
Please select one
CODE OF CONDUCT
Parents, guardians, and participants agree to:
• Show respect toward coaches, volunteers, officials, and fellow participants.
• Demonstrate good sportsmanship.
• Follow all safety instructions.
• Refrain from bullying, harassment, abusive language, or inappropriate behavior.
• Support a positive and inclusive environment.
Blue Wings Soccer reserves the right to remove any participant whose behavior creates safety concerns or disrupts the program.
Agreement
PAYMENT & REFUND POLICY
Payment Method

Blue Wings Soccer accepts payment by e-Transfer only.

Payment Email:

bluewingssoccer.org@gmail.com

Registration is confirmed only after payment has been received.

Refund Policy

Blue Wings Soccer is committed to providing a positive and high-quality soccer experience for all participants.

All refund requests must be submitted in writing by email.

Before Program Start

Full refunds are available if a refund request is submitted at least 7 days before the program start date.

Refund requests made within 7 days of the program start date will be subject to a $50 administrative fee.

After Program Start

Refunds will only be considered for:
- Medical reasons supported by a doctor's note.
- Family relocation outside the London area.
Approved refunds will be prorated based on the number of sessions remaining, less a $50 administrative fee.

Non-Refundable Situations

No refunds will be issued for:
- Missed sessions due to vacation, illness, scheduling conflicts, or other personal reasons.
- Voluntary withdrawal after the program has started.
- Removal from the program due to misconduct or violation of the Code of Conduct.
- Weather & Field Closures.
If a session is cancelled due to severe weather, unsafe field conditions, or circumstances beyond our control, Blue Wings Soccer will make reasonable efforts to provide a make-up session.

Refunds will not be issued for weather-related cancellations.

Blue Wings Soccer Discipline Procedure

Blue Wings Soccer is committed to maintaining a safe, positive, and respectful environment for all participants.

When concerns regarding behavior arise, the following process will generally be followed:

Step 1 – Verbal Reminder

The participant and/or parent will receive a verbal reminder regarding the expected behavior.

Step 2 – Written Warning

If the behavior continues, a written warning may be issued to the participant and/or parent outlining the concern and expectations moving forward.

Step 3 – Suspension or Removal

If the behavior continues, or if a serious incident occurs, Blue Wings Soccer may suspend or remove the participant from the program.

Examples of serious incidents include:
- Physical aggression or fighting
- Bullying or harassment
- Threatening behavior
- Repeated disrespect toward coaches, volunteers, officials, or participants
- Actions that create safety concerns for others
Blue Wings Soccer reserves the right to bypass Steps 1 and 2 when a serious safety issue or major misconduct occurs.

No refunds will be issued in cases involving suspension or removal due to misconduct.

Final Decision

Blue Wings Soccer reserves the right to review and make final decisions regarding all refund requests.

Non-Profit Statement

Blue Wings Soccer is a community-based non-profit soccer program.

All program revenue is used to support program operations, field rentals, equipment, insurance, and youth soccer development.

Our mission is to provide a safe, positive, and high-quality soccer environment where children and youth can develop skills, build character, and grow both on and off the field.
Agreement
PARENT/GUARDIAN DECLARATION & SIGNATURE
I confirm that I am the parent or legal guardian of the participant named in this registration form.

I certify that the information provided is true, complete, and accurate to the best of my knowledge.

I acknowledge that I have read, understood, and agreed to the following documents and policies:

• Medical Emergency Authorization
• Waiver and Release of Liability
• Concussion Acknowledgement
• Photo & Video Consent Selection
• Code of Conduct
• Payment & Refund Policy

I understand that participation in this program is subject to the terms and conditions outlined above.

By signing below, I voluntarily agree to all terms on behalf of myself and the participant.
Participant Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature________________________________________
Date

MonthDayYear
Blue Wings Soccer
Northwest London, Ontario
Developing Skills • Building Character • Inspiring Excellence
Should be Empty:

Blue Wings Soccer

Participant Information

Medical Information

MEDICAL EMERGENCY AUTHORIZATION

WAIVER AND RELEASE OF LIABILITY

CONCUSSION ACKNOWLEDGEMENT

PHOTO & VIDEO CONSENT SELECTION

CODE OF CONDUCT

PAYMENT & REFUND POLICY

PARENT/GUARDIAN DECLARATION & SIGNATURE