Academy Registration

Please let us if you have been affected by the following. 

• Are you allergic to any medication or foods (aspirin, penicillin, etc.)?
• Do you take prescribed medication on a permanent or semi permanent basis (Steroids, anti inflammatory,etc.)?
• Have you ever been told by a doctor that you have epilepsy?:*
• Have you ever been treated for diabetes?:*
• Have you ever been told by a doctor that you were anemic?:*
• Have you ever been told by a doctor that you have sickle cell anemia?:*
• Have you ever been told by a doctor that you have sickle cell traits?:*
• Do you have or ever have high blood pressure? :*
• Do you have or have you ever had Heart Disease (heart murmur, rheumatic fever)?:*
• Do you have or have you ever had Lung Disease (pneumonia)?:*
• Do you have or have you ever had Kidney Disease (infections)?:*
• Do you have or have you ever had Liver Disease (mononucleosis, hepatitis)?:*
• Have you ever been told bya doctor you have asthma?:*
• Do you have or have you ever had a hernia or “rupture”?:*
• Have you ever been “knockedout” (unconscious) in the past 3 years?:*
• Have you had a concussion or other head injury in the past 3 years?:*
• Have you ever had to stay overnight in a hospital due to head injury?:*
• Have you ever suffered a neck injury?:*
• Have you ever broken a bone in the past two years?:*
• Have you ever had ashoulder injury?:*
• Have you had knee surgery?:*
• Do you have a pin, screw or plate in your body?:*
• Do you have any other conditions we should be aware of (ie ulcers, food or insect Allergies, tendinitis, etc.)?:*

ALL PROGRAMS AND ACTIVITIES HAS ITS RISKS
I participate in the game of soccer because it is physically and mentally challenging. In consideration of my participation in such programs, activities and events, I hereby acknowledge that I am aware of the risks and hazards
associated with or related to this activity. The risks and hazards include, but are not limited to:

• Injuries from executing strenuous and demanding physical techniques in soccer;
• Injuries from dryland training including weights, running and massage;
• Injuries from grass, turf and other surfaces including bacterial infections and rashes
• Injuries from collisions with walls and soccer equipment
• Injuries resulting from failure to properly use any piece of equipment or from the mechanical failure of any
  piece of equipment
• Spinal cord injuries which may render me permanently paralyzed
• Injuries from extreme weather conditions which may result in heatstroke, sunstroke or hypothermia
• Injuries from contact, colliding or being struck by other participants, spectators, equipment or vehicles
• Injuries resulting from vigorous physical exertion and strenuous cardiovascular workouts
• Injuries from exerting and stretching various muscle groups; and
• Travel to and from competitive events and associated non-competitive events which are an integral part of the organization’s activities. Furthermore, I am aware:
• That injuries sustained in soccer can be severe;
• That I may experience anxiety while challenging myself during the activities;
• That I may come into close contact with other participants, including the possibility of accidental and
  unexpected contact;
• That my risk of injury is reduced if I follow all rules established for participation; and
• That my risk of injury increases as I become fatigued.

I AGREE TO BE RESPONSIBLE FOR MYSELF
I am participating voluntarily in these activities, events and programs. I agree that there are risks in soccer as described above. By participating voluntarily in these events, activities and programs, I am exposed to these risks and hazards. I agree to accept them and be responsible for any injury or other loss which I might receive while participating in these events, activities and programs.
If something happens to me, I release the organizers of responsibility for any claims, demands, actions and costs which might arise out of my participation. In this Agreement I understand “organizers” to mean: Ontario Soccer, District
Associations, Leagues, Clubs and their directors, officers, members, employees, volunteers, officials, participants, clubs, agents, sponsors, owners/operators of facilities and representative.

INSURANCE
Executing this agreement may not preclude you from insurance coverage.

I ACKNOWLEDGE MAKING THIS AGREEMENT on {date}

 

Registrant Information

Name of Participant: {athleteName}
Address: {address}
Phone: {homeNumber}	Email: {primaryEmail}
Date of Birth:{dateOf}	Registration #: Assigned on Submission
Registering as a:	Player

Team/Organizational Details

Organization:	Eurostar Academy
Season Type Registering for:	Both
Player Classification Indoor:	Youth
Player Classification Outdoor:	Youth Competitive
Team Name: Eurostar Lions	League OASL. Division: Tier 1

Consent for use of personal information
I authorize the Canadian Soccer Association, *Ontario Soccer, the applicable District Association and Eurostar Academy to collect and use personal
information about me for the purpose of receiving communications from the Canadian Soccer Association, Ontario Soccer, District Association,
League and Eurostar Academy. I understand that I may withdraw such consent related to receiving communications at any time by contacting the
Ontario Soccer Privacy Officer at privacy@ontariosoccer.ca or by mail to: Attention: Privacy Officer, Ontario Soccer, 7601 Martin Grove Road, Vaughan
ON L4L 9E4. The Privacy Officer will advise the implications of such withdrawal.
*We do not sell or distribute your personal information to any other third party not listed herein.*

ACCEPTANCE OF TERMS AND CONDITIONS
In consideration of the acceptance of my or my child/ward’s membership in the Ontario Soccer, District Association and Club/Academy, I, the
participant, agree as follows:

1. I understand that I cannot play in any sanctioned soccer game until after this registration form has been validated and the registration data has
been entered in Ontario Soccer’s computerized registration system.
2. I have read and understand the waiver attached and my signature affixed hereto indicates my agreement with such waiver.
3. I am aware of Ontario Soccer, District Association and Club/Academy’s and League bylaws, policies, rules and regulations and agree to abide by
them and to be bound by them.
4. I accept sole responsibility for my personal possessions and athletic equipment and accept all liability for any damage to the playing equipment
caused by my careless, negligent and/or improper handling.
5. I grant permission to the Organization to photograph and/or record my image and/or voice on still or motion picture film and/or audio tape and to
use this material to promote the sport of soccer and the Organizations through the media of newsletters, websites, television, film, radio, print
and/or other form. I understand I waive any claim to remuneration for use of audio/visual materials used for these purposes.

By signing and dating below you agree that you are the player being registered and to be bound by this Legal Agreement even if you have not read this
agreement. 

I ACKNOWLEDGE MAKING THIS AGREEMENT on {date}

(you must review the Participation Agreement below before signing)

By signing this document you will waive some legal rights. This is a binding legal agreement. As a participant and/or parent/guardian of a participant in the programs, activities, games, practices and events of Eurostar Academy Inc and any organization, association or company, Eurostar Academy Inc is are affiliated with, member of, or governed by, the undersigned acknowledges and agrees to the following terms.

Please also note you also agree to our 

Player Contract, Parent Contract & Player Code of Ethics found on our website.

Please read carefully.

Participating in and/or allowing my minor child/ward to participate in the programs, activities, games, practices and events of Eurostar Academy Inc, I assure to you that:

If under the age of 18; I am the parent/guardian of the above-named participant having full legal responsibility for decisions regarding the named participant on the form above.

I am and/or believe that my child/ward is physically, emotionally and mentally able to participate in the programs, activities, games, practices and events of Eurostar Academy Inc and any organization, association or company, Eurostar Academy Inc is are affiliated with, member of, or governed by.

I hereby acknowledge that I am aware of the risks and hazards associated with or related to soccer and other sports. The risks and hazards include, but are not limited to the ones listed in the Ontario Soccer registration Agreement.

The risk of injury is always reduced if I and/or my child/ward follow all rules and regulations developed for participation; and.

I understand and agree, on behalf of myself, my heirs, assigns, personal representatives and next of kin that my signing of this document constitutes: I am registering myself and/or my child/ward willingly and I and/or my child/ward is participating voluntarily in these programs, activities, games, practices and events. I understand and agree that I and/or my child/ward with be exposed to the risks and hazards of soccer.

I accept all of these risks and hazards and understand I am responsible for any injury or loss which I and/or my child/ward might incur while participating in any programs, activities, games, practices and events of Eurostar Academy Inc and any organization, association or company, Eurostar Academy Inc is are affiliated with, member of, or governed by.

If anything happens to me and/or my child/ward, I hereby release Eurostar Academy Inc and any organization, association or company which Eurostar Academy Inc affiliates with, is a member of and/or governed by; of all claims, demands, actions and costs which may arise from my and/or my child/wards participation. This releases all directors, officers, members, employees, volunteers, officials, participants, academies, clubs, agents, sponsors, owners/operators of facilities and representatives of Eurostar Academy Inc, and any organizations, association or company which Eurostar Academy Inc affiliates with, is a member of and/or governed by.

I agree to release Eurostar Academy Inc from liability for any and all claims, demands, actions and costs that arise out of my and/or my child/wards participating, even though risks, injuries, loss, damage, claims, demands, actions or costs may have been caused by the negligence of Eurostar Academy Inc.

I give consent of my and/or my child/wards picture, video, likeness and/or name to be used in any Eurostar Academy Inc newsletter, email, magazine, newspaper article, advertisement, website article or any other media type use for promoting Eurostar Academy Inc and earning royalty revenue from our produced digital images and video.

Insurance – Signing this agreement will not preclude you and/or your child/ward from accident insurance coverage, subject to the terms and conditions of Eurostar Academy Inc’s insurance policy.

Discrimination, Harassment and Bullying – All Eurostar Academy Inc participants have the right to participate in programs, activities, games, practices and events that are in a discrimination, harassment and bullying free environment.

By signing and dating below you understand and agree that you are the registered player (18 years old +) and/or the registered player’s legal parent/guardian and are bound by this agreement even if you did not read the agreement. I agree to participate (or allow this child to participate, if signed on behalf of a minor) in the activities of Eurostar Academy Inc. I understand and accept that there is a potential risk in training and participating in any sport; and, that the Academy tries to deliver a safe environment. I agree not to hold Eurostar Academy Inc, its Directors, its Staff or Volunteers liable for any damages; loss; or injury sustained by this child and/or by me as a consequence of his/her/my participation in; or presence at; any programs, games, events or other activities of Eurostar Academy Inc and hereby release them from such claims.

I agree on my behalf (and on the behalf of this child if signing for a minor) and on behalf of any family member who may attend programs, practices, games or Academy events to abide by the rules, polices and decisions of Eurostar Academy Inc and any organization, association or company Eurostar Academy Inc is affiliated with, member of, or governed by. Proper conduct on and around the field must be followed. I accept sole responsibility for my and/or child/ward’s personal possessions and athletic equipment. I accept all liability for any damages to the playing equipment caused by my and/or my child/ward’s negligent and/or improper handling. I specifically grant permission to Eurostar Academy Inc to use my/my child’s likeness, voice and words in television, radio, film, newsletters, magazines, website, and other media; and, in any form not heretofore described, for the purpose of advertising, instructing or communicating activities of Eurostar Academy Inc.

I hereby certify that all of the information provided on this form is accurate and complete. I have read, understand, and I accept, all of the terms and conditions that are stipulated in this registration document, including the attached participation agreement and understand it is bound by the legal agreement even if you have not read the agreement.