SURREY BREAKERS ATHLETIC ASSOCIATION (SBAA)

A Club 100% Dedicated to Girls’ Soccer - Hostess of the Cloverdale Cup

Box #34205 17790 #10 Hwy Surrey, BC V3S- 8C4 Telephone 604-599-0197

Website Address: www.surreybreakers.com

REGISTRATION APPLICATION 2009-2010

PLAYER’S NAME________________________________________________________________________________

Last Name First Name Middle Name (required)

DATE OF BIRTH ___________________________________ HOME PHONE________________________________________

Month/Day/Year

ADDRESS______________________________________________________________________________________

Street Address City Postal Code

E-MAIL_____________________________ PARENT (S)/GUARDIAN (S) NAME______________________________

NAME FOR TAX RECEIPT PURPOSES______________________________________________________________

Last Name First Name

LAST TEAM & CLUB ______________________________________________________________________________

2008 - 2009 Season

LAST AGE & DIVISION (i.e. U14 Silver)___________________________________________________________________

2008 -2009 Season

EMERGENCY CONTACT (SHOULD PARENT BE UNAVAILABLE)

Name_________________________________________________________________________________________

Home Phone______________________________________ Cell Phone____________________________________

REGISTRATION FEES:

U-6 U7 Born in 2004 - 2003 $ 250.00

U-8, U-9, U10 House Born in 2002 - 2001 - 2000 $ 275.00

U-10 Development*, U-11*, U12 Born in 2000 – 1999 – 1998 $ 295.00

U-13, U-14 U-15, U-16, U-17, U-18 Born in 1997 - 1992 $ 325.00

METRO $ 375.00

Family Rate: 2 oldest players pay full fee, any additional daughters pay half fee.

THREE CHEQUES MUST ACCOMPANY REGISTRATION APPLICATION

(Cheques payable to SBAA). Cash cannot be accepted

1. Registration Fee (Cheques may be post dated no later than June 30, 2009)
2. $50.00 uniform deposit - post dated to April 30, 2010 - Cheque will be destroyed when uniform is returned in the condition in which it was issued
3. $50.00 Parent Participation Fee - post dated to April 30, 2010 - Cheque will be destroyed when a parent completes participation in Club activities.

• NSF cheques will be charged a $25.00 processing fee from the SBAA
  

*Copy of birth certificate is required for the following:

ALL U10 Development and U-11 girls (players born in 2000 playing select and players born in 1999)

ALL NEW girls in Division U12 to U18 (players born in 92 - 98)

*A small photo (2” x 2”) is required for the following:

ALL U10 Development and U11 girls (players born in 2000 playing select and players born in 1999)

ALL NEW girls in Division U13 to U18 (players born in 92 – 97)

*** NEW PICTURES FOR all new and returning U14, U-16 AND ALL Metro players. ***

WAIVER

I, the undersigned, a parent or legal guardian of the player herein registered, in consideration of goods and valuable consideration, the receipt of which is acknowledged, for themselves, their heirs, executors, administrators, and assigns, hereby release and forever discharge the SURREY BREAKERS ATHLETIC ASSOCIATION, SURREY BREAKERS GIRLS’ SOCCER CLUB and/or the SBAA GIRLS SOCCER CLUB, its coaches, players and others involved in the activities of playing soccer from any and all actions, causes of actions, claims and demands for or by reason sustained in consequence of any activity of the soccer association and for the said consideration the undersigned agrees not to make claim or take proceedings against any other person or corporation who might claim or take proceedings against any other person or corporation who might claim contribution of indemnity under the provisions of any statute or otherwise.

And, it is hereby declared that the terms of this release are fully understood.

SIGNATURE_____________________________________________DATE________________________

PLAYERS ARE NOT REGISTERED UNTIL THE REGISTRAR RECEIVES BOTH THIS FORM AND PAYMENT.

• NO REFUND WILL BE MADE IF REQUESTED AFTER SEASON COMMENCEMENT. (a $20.00 processing fee is charged for any refunds before season commencement).
• Placement on a team (in keeping with CLUB POLICY) can be requested but is not guaranteed.

IT IS MANDATORY THAT PLAYERS WEAR SHINPADS AND SOCCER CLEATS FOR ALL GAMES

• All players are invited to our Christmas Party. All players U12 and younger participate in our soccer skills development program in addition to playing games.

Volunteers

SBAA Girls’ Soccer is parent participation, volunteer, non-profit organization dedicated to providing a quality soccer playing experience to girls and women of all ages and abilities. Can you help? In September all parents will be assigned Parent Participation jobs (PPFs).

I am interested in helping my daughter’s team as a ___ Coach ___ Assistant Coach ___ Manager

I am interested in helping SBAA as an ____ Executive Member

COMMENTS/REQUESTS/MEDICAL CONCERNS:

REGISTRATION APPLICATION MAY BE MAILED TO THE following Addresses:

6215 Sundance Dr., Surrey, BC V3S 8A9

OR DROPPED OFF AT: (Drop off from March until August 30th only)

Cloverdale Recreation Center 6220 184th Street, Surrey

____________________________________________________________________________________

CLUB USE ONLY

Date received: ______________________________ 2009

Registration Fee: Cheque #________ Amount Paid - _________________

Uniform Deposit: Cheque #________

PPF Deposit: Cheque #________