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Athlete Information

First Name

Last Name

Email

Phone

Which program are you interested in?

Which province are you registering for? *

Manitoba (Winnipeg)

Ontario (Ottawa)

Are you a Canadian Citizen? *

Yes

No

Are you a Permanent Resident? *

Yes

No

If you are NOT a Canadian citizen, what is your country of origin?

Are you Indigenous/Aboriginal? *

Yes

No

If you answered YES to Permanent Resident, what is your Permanent Resident #?

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Birthday

Manitoba Health Card Number (9-digit)

Name Of Emergency Contact

Phone Number of Emergency Contact

Parent/Guardian Information (if under 18)

First Name

Last Name

Relationship to Participant

Address (if different from athlete)

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Additional Athlete Information

Name of school

What position(s) do you play?

Do you play for a Club? *

Yes

No

If you answered YES, which club?

T-Shirt Size (Youth) *

S

M

L

XL

Program Fees *

$200 l Mini's Soccer Program

$200 l Youth Soccer Program

$150 l Youth Basketball

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