First Name *
Last Name *
Date of Birth *
Gender * —Please choose an option—MaleFemale
T-Shirt Size * —Please choose an option—XSSMMLXL
Street Address *
City *
Province* OntarioQuebecNova ScotiaNew BrunswickManitobaBritish ColumbiaPrince Edward IslandSaskatchewanAlbertaNewfoundland and LabradorYukonNorthwest TerritoriesNunavut
Postal Code*
Home Number
Cell Number
Email*
Mother's Name
Mother's Cell
Father's Name
Father's Cell
Person’s Authorized to pick up child
Other Dismissal Arrangements
Specify any of your child’s health problems
Is your child on any medication? * —Please choose an option—YesNo
If child is on an medications, please specify
Select a Program * —Please choose an option—Brampton Soccer Centre (Saturday) – $300Brampton Soccer Centre (Sunday) – $300Sandalwood Heights Secondary School (Monday) – $250McCrimmon Middle School (Friday) – $250
How did you hear about us? * —Please choose an option—GoogleFacebookInstagramFamily / FriendsOther
I have read and agree to the Northern Lions Youth Soccer Club Assumption of Risk and Waiver of Liability.. I consent to receiving marketing and updates text messages from Northern Lions Youth Soccer Club at the cell number provided. I consent to receive non-marketing text messages from Northern Lions Youth Soccer Club about the registration, practice reminders, details and etc. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt-out
Review our Privacy Policy | Terms and Conditions
Programs operate on a first-come, first-served basis, and group sizes are limited. Secure your child’s spot for the upcoming season.
