Competitive Registration

Athlete's First Name *

Athlete's Last Name *

Registration Zone *

-- Please Select -- Antigonish, NS Colchester, NS Cumberland, NS Pictou, NS Westmorland, NB

Athlete's Gender *

M     F

Athlete's Age *

Athlete's Birthday *

Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   Day 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  

T-Shirt Size *

-- Please Select -- Youth Small Youth Medium Youth Large Youth X-Large Adult Small Adult Medium Adult Large Adult X-Large

Parent/Guardian Name 1 *

Parent/Guardian Name 2

Address *

Village, Town or City (Example: Sackville) *

Province *

Postal Code *

Home Phone *

Cell Phone

Email *

Alternate Email

Emergency Contact Name *

Emergency Contact Phone *

Please let us know about any medical issues or chronic injuries.

Note: Please read the Waiver of Liability and Release carefully to ensure full understanding.

I, a Participant in Atlantic Futsal events, activities and programs, in consideration for my voluntary participation in Atlantic Futsal events, activities and programs, acknowledge that I understand and agree as follows:

1. Atlantic Futsal events, activities and programs include among others futsal, running and soccer programs. These physical sports involve the risk of injury.
2. I agree: a) To assume all risks arising out of, associated with or related to my participation; and b) To release Atlantic Futsal from liability for any and all claims, that might arise out of my participation.
3. I consent to be contacted by Atlantic Futsal and its employees by way of electronic mail, telephone, and social media.
4. I authorize my photograph, or likeness, and voice to appear in any promotion or video (including advertising) of Atlantic Futsal events, activities and programs, without notice or compensation.

Acknowledgement *

All Atlantic Futsal participants are legal minors and their parents, natural guardians or legal guardians must read and sign the following acknowledgement on their behalf.

As the parent and natural guardian or legal guardian of the Participant, I hereby agree to the foregoing Waiver of Liability and Release for, and on behalf of, the Participant named in the above registration form.