YFC Soccer Registration Form

YFC Futsal League Registration

Every registered youth will be put onto a team depending on a variety of factors. Where youth live, whether or not they need special transportation arrangements, preferred language, weekly availability, and friend groups will all be taken into account. If there's someone specific you would like on your team or if you would like to be on a certain team, please indicate as such in the "Further Comments/Requests" section. We cannot guarantee we will be able to accommodate every request.
Dear Parent/Guardian,

Please take the time to read over this form and fill out the necessary information. If you have any questions or concerns, please contact me at any time.

As a year round program, our greatest desire is to provide care and support for your teenagers at every level. This means we will give them opportunities to grow physically, emotionally, spiritually, mentally, and relationally. We will use the Bible as a guide to explore what it means for us to have a personal relationship with God.

- Brock Groening, YFC Soccer Director
Participant Information
Full Name*

First NameLast Name
Have you played one or more full seasons at YFC Soccer?

YesNo
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Preferred Position*
School*
Grade*
Country of Origin
Where were you born/where did you grow up? We're just curious.
Primary Language (select all that apply)

EnglishFrenchOther
Health Card Number*

If yes to any of the previous questions, please explain:
Further Comments/Requests
Typical league nights will be Wednesdays (Northeast Division) or Thursdays (Central Division) from 7-10 pm. We understand that sometimes youth are enrolled in other programs/sports teams and have weekly commitments. Please let us know if one or more of these nights are regularly committed to other weekly activities and we will do our best to accommodate.
Brock's Email
example@example.com
Parent/Guardian Information
Parent/Guardian*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Primary Phone Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
E-mail*
example@example.com
Emergency Contact Information
Same as Parent/Guardian info above?*

YesNo
Name of Emergency Contact*

First NameLast Name
Relationship to Participant*
Phone Number*

Area CodePhone Number
Payment Information

Cost for the whole year is $50/youth. HOWEVER, we will give you a $20 discount if you refer a friend to the program. This will be reimbursed to you when they register as a program participant and credit you with a referral.
Are you new to the program?

YesNo
Were you referred by a friend?

YesNo
Which friend referred you?
Please indicate which form of payment you will be using:*

CashChequeCredit Card
Please give payment to Brock or Kyle during the next night of programming or drop off at the front desk of the YFC building* (333 King St.).

*If dropping off at the front desk of YFC, be sure to indicate on an envelope what payment is for.
Please process payment over the phone by calling 204-669-4205. Be prepared to give your credit card information.

Alternatively, you can come pay with credit card at the YFC building (333 King St.). Regular hours are weekdays 9am-5pm.
Liability Waiver
Please read carefully and indicate below that you have read and agreed to the following terms:

I understand that in the event a medical intervention is needed, every attempt will be made to contact immediately the persons listed on this form. In the event I cannot be reached in an emergency during the soccer program activities, I hereby give permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or order an injection, anesthesia, or surgery for my child that is deemed necessary.

I understand all personal safety precautions will be taken at all times by Youth for Christ and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent risk. I agree not to hold Youth for Christ, its leaders, and its volunteer staff liable for damages, losses, diseases, or injury incurred while participating in this activity.

As the parent/legal guardian of the particpant(s) listed in this form, I have reviewed the information about the event/activity and give my permission for the participant(s) of this release to be involved in the overall activities of the soccer program. I also authorize the use of photos or video of the participant(s) listed in this form by Youth for Christ for website/publicity purposes.

I understand the need for certain rules to be in place during this activity and agree that the participant of this release will abide by them.
I, the above-named parent/guardian of the participant listed in this form, understand and agree to these statements.
I agree to these statements.
Send me emails regarding future YFC Soccer events such as tournaments, summer camps, and league registrations.
Should be Empty:

	Yes	No
Preexisting medical conditions
Medications currently in use
Allergies
Hay fever/heart conditions/diabetes
Epilepsy/nervous Disorder/asthma
Stomach problems/physical handicap
Major illness over the past year
Contact lenses
Activity Restrictions

YFC Futsal League Registration

Participant Information

Parent/Guardian Information

Emergency Contact Information

Payment Information

Liability Waiver