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Soccer7s

Player Registration Form - Soccer 7s - Summer 2017

 

Soccer 7s - Summer 2017 - Adult Player Registration Form

The RA Membership fee is already included in your Coliseum Soccer Membership, however as part of the agreement with the RA, all Soccer 7’s players must become registered RA members. This membership affords you all of the benefits available to an RA Member. See the RA’s website www.racentre.com/benefits or contact RA Member Services at 613-733-5100 for further details.

Last Name (*)

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First Name (*)

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Date of Birth (*)

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Gender (*)

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Telephone - primary (*)

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Telephone - other

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Address (*)

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City (*)

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Province (*)

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Postal Code (*)

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Email (*)

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Do you work for or have you retired from the Federal Government? (*)

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Which Department?

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Emergency Contact Name (*)

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Relationship (*)

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Telephone - primary (*)

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Telephone: other

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Is there anything that we should have on file regarding your health status? (*)

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Please explain

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We request your understanding and cooperation in maintaining safety for both you and the RA as well as your privacy and health by reading and signing the following:

Are you interested in receiving these?

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DISCLAIMER AND WAIVER


I have read and accept the Informed Consent and Disclaimer and waiver above.

(*)

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Verification
Verification

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RA Centre  |  2451 Riverside Drive, Ottawa, ON K1H 7X7 | 613.733.5100 | racentre@racentre.com

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