Summer Development Program Registration - Northern Lions

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 (Please provide proof of id)

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—Save Max Sports Centre- TURF FIELD (Saturday - FULL, PLEASE CALL US) - $230Save Max Sports Centre- TURF FIELD (Sunday - FULL, PLEASE CALL US) - $230Sandalwood Heights Secondary School (Monday - FULL, PLEASE CALL US) - $190Fletchers Meadow Secondary School (Friday - FULL, PLEASE CALL US) - $190

I hereby state that the participant is in good mental and physical health condition to participate in the activities provided by Northern Lions Youth Soccer Club, including but not limited to all aspects of soccer. I am fully aware that any activity involving motion, height or athletic activity creates the possibility of serious injury. I hereby release Northern Lions Youth Soccer Club, its employee and its staff from liability to the above named athlete, of the person claiming through him/her, arising from injury to the person or property of the above named athlete occurring in the premises of Northern Lions Youth Soccer Club, including any event sponsored or sanctioned by Northern Lions Youth Soccer Club, and or travel to and from such activities. I understand that Northern Lions Youth Soccer Club, has the right to deny admittance to any student not meeting the standards of the program as it sees fit. I also agree not to hold these parties responsible in the event that my son/daughter/child engages in inappropriate conduct (including, but not limited to disruptive or volatile behavior in or out of camp, etc.) or becomes involved in any activity or with any persons not associated with Northern Lions Youth Soccer Club, or its scheduled program and that Northern Lions Youth Soccer Club, has the right to send him/her home for inappropriate conduct. I also give permission for my child to be photographed or recorded for marketing purposes. I further attest that the information contained in this application is correct to the best of my knowledge. In addition, I have agreed to the policy and fee statement and agree to comply. Participant(s) and/or Parent(s) acknowledge and freely accept this risk and voluntarily release and discharge Northern Lions Youth Soccer Club from any actions, claims, suits, grievances and demands whatever nature in law, in equity or pursuant to any statute, relating to or arising from any injuries, damage or loss to personal property, however arising, that any Participant(s) and/or Parent(s) may suffer while participating in any event whether as part of this agreement or not.

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