Registration Form

Mainland Registration Form

Registration

Registration is now open for the 2020 season.

All late registrants will be placed on a wait list and you will receive notice of your status before April 13th, 2020.

Fees:

$190 Early Bird Registration until April 1, 2020. Pay by cash, cheque or e-transfer.

$195 Early Bird Registration until April 1, 2020. Pay by visa.

10% surcharge for all late registrants will be charged after April 1st, 2020.

All players will receive a t-shirt jersey.

(*) required field

First Name: *
Last Name: *
Phone Number: *
Street No. & Name: *
City: *
Province: *	Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Postal Code: *
Email Address: *
Date Of Birth (yyyy-mm-dd): *
Age: *
Gender: *	Male Female
Guardian – Mother
First Name:
Last Name:
Phone Number:
Email Address:
Guardian – Father
First Name:
Last Name:
Phone Number:
Email Address:
Medical Information
Allergies :
Family Doctor – Name:
Family Doctor – Phone Number :
Emergency Contact
First Name:
Last Name:
Phone Number:
Survey
First year with Mainland?:	Yes No
How many years have been playing soccer?	1 2 3 4 5 6 7 8 9 10+
How many years have you played with Mainland Athletics?	1 2 3 4 5
Shirt
Shirt Size:	Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large
Registration Early Bird Registration Fee:      $190 Early Bird Registration until April 1, 2020. Pay by cash, cheque or e-transfer.      $195 Early Bird Registration until April 1, 2020. Pay by visa. 10% surcharge for all late registrants will be charged after April 1st, 2020.
Select Registration Plan:	$190 $195

Payment
	$190 Cash/Cheque (Mail cheque to Mainland Athletics: 10700 Maddocks Road, Richmond, BC, V7A 3M5, Reference your child’s name)
	$190 e-transfer (Please email to info@mainland-athletics.com. (In a separate email please email password and reference your child’s name in the subject line)
	$195 Visa or MasterCard (Call Mainland Athletics at 604.789.2486 to complete your VISA or MasterCard transaction)
Photo Release
	As the parent/guardian of the player listed above, I authorize Mainland Athletics to use photo images of the youth for Mainland Athletics media, promotional, and or website content purposes.
Liability
	As the parent/guardian of the player listed above, I agree that the youth is physically and medically fit to participate in the Mainland Athletics soccer development program.I also agree that Mainland Athletics and its management team, coaches and contractors will not be held accountable for any personal injuries that may arise from the registered player participating in any Mainland Athletics soccer development program activities.
Approval (Please type your name) I agree to all the terms and conditions listed above.
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