RD #: _____
YEAR: 20___
* TEL: 1-888-838-5274 * FAX: 905-270-7573 * theacademy@bellnet.ca * * www.reddevilsacademy.com *
AC A DE M Y RE GIS T RA TI O N F O R M PLAYERS REGISTRATION INFORMATION PLAYERS NAME:
DOB:
PARENTS NAME: FATHER:
MOTHER:
ADDRESS:
PROV:
HOME PH #:
/
(M/D/YR)
PC:
BUSINESS PH #:
E-MAIL:
/
CELL PH #:
PARENTS E-MAIL:
IN CASE OF EMERGENCY, PLEASE CONTACT: NAME:
PHONE #:
RELATIONSHIP:
P L A Y E R S E N R O L L M E N T I N FO R M A T I O N DATE ENROLLED:
SESSION ENROLLED: WINTER SESSION 1/2/ SUMMER/ TC/ PT
CLINIC ENROLLED: ACADEMY/ ELITE/ MVP/ GK/ LDA/ PDP/ PERSONAL TRAINING/ TRAINING CAMP LEVELS PLAYED: HOUSE LEAGUE/ ALL STAR/ SELECT/ REP/ INDOOR/ SCHOOL/ FUTSAL SKILL LEVEL: BEGINNER/ INTERMEDIATE/ ADVANCED/ NTC-PROVINCIAL/ INTERNATIONAL ARE YOU CURRENTLY SIGNED WITH A CLUB OR ACADEMY?
YES/ NO
CLUB/ ACADEMY NAME (IF YES):
PAYMENT INFORMATION A M O U N T O F P A YM E N T : $
M E T H O D O F P A Y M E N T: C C / C A S H / M O / S P O N S O R
DA T E P YT R E CE I V E D:
P ROG RAM :
C L I N I C N A M E:
T H E R E W I L L B E N O R E F U N D S A F T E R T W O ( 2 ) A T T E N D E D S ES S I O N S PLEASE MAKE CHEQUES/ MO/ SPONSOR CHQS PAYABLE TO:
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RDA 2235 HURONTARIO ST., SUITE 1114A MISSISSAUGA, ON L5A 2G1
RD #: ______ PLAYERS MEDICAL INFORMATION
IS
IN GOOD PHYSICAL CONDITION? YES/ NO
IF NO, WHAT IS THEIR CURRENT PHYSICAL CONDITION? ARE THERE ANY EXISTING MEDICAL CONDITIONS THAT WILL PREVENT PHYSICAL EXERCISE? YES/ NO IF YES, WHAT IS THE SPECIFIC MEDICAL CONDITION(S)? DOES
HAVE ANY ALLERGIES? YES/ NO
IF YES, WHAT ARE THEY ALLERGIC TO? IS THERE ANY OTHER RELEVANT HEALTH INFORMAION THAT NEEDS TO BE NOTED? YES/ NO IF YES, PLEASE EXPLAIN (PLEASE BE SPECIFIC):
A C CE P T A N CE A N D W A I V E R I, AS LEGAL GUARDIAN OF THE APPLICANT, HE REBY GRANT PERMISSION TO PLAY AND TRAIN AT SOCCER AND UNDE RSTAND THAT THE RE GISTRATION FEE DOES NOT INCLUDE ME DICAL COVE RAGE. I AGREE TO RELE ASE AND INDE MNIFY THE RE D DE VILS ACADE MY (RDA), IT’S OFFICE RS AND MEMBE RS FROM ANY AND ALL CLAIMS ARISING FROM INJURIE S INCURRED BY THE APPLICANT WHILE PLAYING AND TRAINING IN THE RED DEVILS ACADE MY (RDA)’S TRAINING SESSIONS. THE RE D DEVILS ACADEMY (RDA) WILL NOT BE HELD LIABLE AND/ OR RESPONSIBLE FOR ANY PREEXISTING ME DICAL CONDITION OF ANY NATURE. THE APPLICANT ALSO AGREE S TO ABIDE BY ALL RULE S, REGULATIONS AND DECISIONS OF THE RE D DEVILS ACADEMY (RDA) WITHOUT PREJUDICE. IN ADDITION THE APPLICANT HAS SIGNE D A COPY OF THE CURRENT RDA CODE OF CONDUCT OUTLINING THE RED DEVILS ACADE MY (RDA)’S POLICIES AND PROCE DURES. SIGNING THIS FORM ALSO GUARANTEES THAT ALL PAYMENTS OF FEES WILL BE ME T IN FULL AT THE BEGINNING OF THE TRAINING PE RIOD. SIGNATURE OF PARE NT/ GUARDIAN:
SIGNATURE OF PLAYE R:
INTERNAL USE ONLY DATE ACCE PTE D:
DATE PROCE SSE D:
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RD #: ______
RDA MEDICAL AUTHORIZATION NAME ____________________________________________________ AGE ________DATE of BIRTH __________-___________-__________ (M) (D) (YR) ADDRESS _________________________________________________ CITY __________________________PROV ______PC _____________ PHONE ( __________) _______________________________________ SCHOOL ____________________________________ GRADE ______
I hereby give my permission for _______________________________________________to participate in activities that the RED DEVILS ACADEMY staff may authorize. These activities may include but are not necessarily limited to soccer training, tournaments, games, practices and social events. In the event of an accident, illness or injury to _________________, in the absence of the parents or legal guardian, I hereby authorize the RED DEVILS ACADEMY staff to obtain transportation (ambulance or other) to the nearest medical care facility and further authorize emergency medical treatment as required. I further agree to pay any and all expenses incurred therewith. PARENT'S NAME____________________________________HOME PHONE______________________ ADDRESS_________________________CITY_____________________PROV_______PC___________ FATHER'S CELL PHONE_____________________MOTHER'S CELL PHONE____________________ REGISTRANT'S CELL PHONE_____________________OHIP #:_____________________________ INSURANCE COMPANY_____________________________POLICY or ID NO.___________________ ADDRESS____________________________CITY____________________PROV______PC__________ LIST ALLERGIES or DISORDERS________________________________________________________ ___________________________________________________________________________________________ FAMILY PHYSICIAN______________________________________ _____________
PHONE (______)
Signed and Witnessed by:
Parent or Legal Guardian
Name
Witness
Dated __________ day of ____________________, 20_____
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Name
RD #: ______
RDA PLAYER TRAINING CONTRACT NAME ____________________________________________________ AGE __________DATE of BIRTH __________-__________-_________ (M) (D) (YR) ADDRESS _________________________________________________ CITY _________________________PROV ______PC ______________ PHONE (___________)
_____________________________________
SCHOOL ___________________________________GRADE ________ Having discussed this player contract with ________________, and believing the RED DEVILS ACADEMY to be beneficial to him/her, I/We hereby give our consent and permission for him/her to participate as a member of the RED DEVILS ACADEMY’S assigned training. I/We will give support and assistance to him/her as our time permits. I/We certify that the date of birth shown above is correct and I/We agree to abide by the terms of this contract. I/We acknowledge the RED DEVILS ACADEMY to be a reputable youth organization supervised and administered primarily by trained coaches and volunteers. I/We hereby covenant and agree to indemnify and to hold and save harmless the RED DEVILS ACADEMY, its agents, servants, representatives, officers, and coaches from and against all actions or causes of actions, claims, demands, liabilities, loss, damage or expense of any kind, which may be sustained or incurred by virtue of injury or damage to us or our son/daughter, resulting from or growing out of participation in any activity of the academy. Although organizations with whom our team or club register or play may provide insurance, I/We understand that the RED DEVILS ACADEMY does not carry additional insurance to cover injury to our son/daughter while participating in the activities of the academy or academy team. I/We hereby acknowledge the receipt of a sheet of facts detailing the cost to participate and I/We further agree to meet that commitment in full. Each player is to provide the academy staff with a completed contract and the appropriate fees before he/she will be eligible for train and I/We further agree to keep current with our financial obligations. I/We understand that players, parents and spectators will encourage good sportsmanship and agree to conduct themselves in an exemplary manner at all times. Should, at any time, a condition exist that is questionable in this context, the offender will be asked to leave the premises. Intoxicating beverages or illegal substances will not be permitted or tolerated at any academy training activity. I agree to take part in and to uphold the duties and responsibilities of a player for the RED DEVILS ACADEMY and I further agree to conduct myself in the true manner of good sportsmanship and high character at all times.
Player's Signature: __________________________________
Date: ______________
Parent or Legal Guardian: _________________________________________________ Name Signature Witness: _________________________________________________________________________ Name Signature
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