Emmanuel Baptist Church - Oshawa

Soccer Pre-Registration

• Name of child*
  First Name

  Last Name
• Grade
  This is the grade your child is in currently.
  Grade One

  Grade Two

  Grade Three

  Grade Four

  Volunteer
• Date of Birth (Players and Volunteers under 18 only)
  MM

  /

  DD

  /

  YYYY
• Phone Number*
   

  (###)

  -

  ###

  -

  ####
• Address
  Street Address

  Address Line 2

  City

  Province / State / Region

  Postal Code / Zip

  Antigua and BarbudaBahamasBarbadosBelizeCanadaCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNicaraguaPanamaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColumbiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosCongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauCôte d\'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandTanzaniaTogoTunisiaUgandaZambiaZimbabwe

  Country
• Your E-mail
   
• Name of parent*
  First Name

  Last Name
• Shirt Size (youth sizes)
  Small

  Medium

  Large

  Volunteer - you can tell me later :)
• I give permission for my child to participate in the clubs sponsored by Emmanuel Baptist Church Oshawa Inc. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Emmanuel Baptist Church or any of its leaders, coaches, assistants or volunteers liable for damages, injuries or loss incurred.
  Yes I agree.
• We make every effort to take a Club Photo and have that printed and available to you on the last day of soccer. Do we have your permission to take photos of your child for this purpose and to possibly have them on our website? (If no, then please make sure your child does not go with the group on Photo Day. We will announce this day for you).
  Yes

  No
• EBC runs family programing all year long! Do we have your permission to contact you about upcoming events for all ages?
  Yes

  No
• How did you hear about LITE Soccer?
  Flyer from School.

  A friend.

  Through another program at EBC.

  Other.
• What school does your child attend? (This helps us decide where to target our programs).
  College Hill Public School

  Glen Street Public School

  Cannon Public School

  Lake Woods Public School

  Bobby Orr Public School

  Other