JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Sackville Youth Soccer Registration
Contact
gregormacaskill@bellaliant.net
for questions.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Player First Name
*
Your answer
Player Last Name
*
Your answer
Sex (this determines which league will be joined for ages: Under-11, Under 13, Under 15, & Under 18)
*
Female
Male
Date of Birth - Day
*
Choose
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Date of Birth - Month
*
Choose
January
February
March
April
May
June
July
August
September
October
November
December
Date of Birth - Year
*
Choose
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003 or before
Mailing - Street
*
Your answer
Mailing - Community
*
Your answer
Mailing - Postal Code
*
Your answer
Telephone number (###) ###-####
*
Your answer
Email address for soccer updates (use commas to separate two or more emails)
*
Your answer
Parent / guardian 1
*
Your answer
Parent / guardian 2
Your answer
Parent / Guardian consent and agreement:
*
I hereby agree that my child can participate in the activities of the Sackville Youth Soccer Association.
I certify the date of birth provided is correct
I understand that Sackville Youth Soccer Association may need to follow Public Health Directives and programs may change through the season
I am prepared to sign a separate waiver related to Covid-19 risks to be provided by Sackville Youth Soccer Association
Required
**NOTE FEES HERE for payment** Indicate what age group you expect your child to join and determine your fee payment:
*
Choose
Under 4 (born in 2017 or later) please contact Curtis at cmichaelis@mta.ca to express interest.
Under 5 (born in 2018 or 2019) Tu/Th evenings at TRHS - $100
Under 7 (born in 2016 or 2017) Tu/Th evenings at TRHS - $100
Under 9 (born in 2014 or 2015) Tu/Th evenings at TRHS - $100
Under 11 (born in 2012 or 2013) Tu/Th evenings at TRHS - $125
Under 13 (born in 2010 or 2011) Tu/Th evenings at TRHS - $150
Under 18 (born in 2005, 06, 07, 08, or 09) Mo/We evenings at Lorne St Field - $150
Senior Men (born 2004 or before) - $200
Senior Women (born 2004 or before) - $175
Starting the week of May 15th we will have the MTA turf field booked for 3-4 weeks. The times are tentatively at 6pm for 1 hour. The U-15 and U-18 teams will practice Mon/Wed, then U-11 and U-13 teams will practice Tue/Thu. Please indicate your availability below:
*
Not applicable to my age group (i.e. U5, U7, or U9) will start second week in June.
Yes, I am able to start in May for my age group (i.e. U11 or older).
One of the nights each week will conflict with activities I am already committed to in May.
Both of the nights will conflict with activities I am already committed to in May.
I can make most nights in May, but I may miss a couple due to conflicts.
**Payment by email interact: Email interact payment to Gene Ouellette <
gouellette@mta.ca
> with email indicating what player(s) the payment is for, or make cheque payable to Sackville Youth Soccer Association (SYSA). **Registration is not confirmed until payment is received. All players must be registered for insurance coverage to play or practice. **Teams need a minimum number of players; if your age group does not have enough players, full refunds will be given. **The late registration penalty is $10 (after Sun May 14th) and late registration is subject to availability of space on each team.
*
I have read and understand the above.
Required
Player's Medical Information
*
I understand this will be given to the player's coach for emergency use only.
Required
Primary emergency contact - Name:
*
Your answer
Primary emergency contact - Telephone:
*
Your answer
Secondary emergency contact - Name:
Your answer
Secondary emergency contact - Telephone:
Your answer
Family doctor - Name:
Your answer
Family doctor - Telephone:
*
Your answer
Medications:
Your answer
Allergies:
Your answer
Medicare number
*
Your answer
Previous injuries:
Your answer
Does the player carry medication? (if player does not know how to administer it, please note below)
Yes
No
Not applicable
Clear selection
Please indicate any other medical conditions, syndromes, disorders, special needs, or behavioural issues that coaches should be aware of:
Your answer
You will receive a confirmation email when you submit this form. You will hear from coaches and coordinators with further details about the start of the season. If you do not receive an email confirmation or have any questions, then please contact
gregormacaskill@bellaliant.net
.
I have checked all of the information above to make sure it is correct.
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
