Player's First Name *
Player's Last Name *
Mother's First Name *
Mother's Last Name *
Father's First Name *
Father's Last Name *
Emergency Contact Name *
Emergency Contact Phone Number*
What are you registering for?
---Summer Sessions - June to August
Your E-mail *
Child's Birth Date *
Your Address *
---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanNorthwest TerritoriesNunavutYukon
Subsidized fee $150 per player, per program (Summer program).
Online Registration REQUIRED for all kids in each Category.
Registration Payment Option
---Interac e-TransferMoney OrderPay Online
All checks payable to African Canadian Soccer or ACSCA with memo your child's LAST NAME. Please Email Interac e-Transfer to email@example.com with password PLAYER's LASTNAME
Canadian Tire Jumpstart Program sponsors part of our Youth Soccer Program. Can we share your information with them so they can talk to you directly regarding the program?
I, the parent/guardian of the above named player, a minor, agree that I and the player will abide by the rules and regulations of Africa United FC, its affiliated organizations and sponsors. In consideration of the player's participation in the soccer programs intending to be legally bound, I hereby release and indemnify Africa United FC, and its owners and operators of the facilities used for the programs and their respective directors, officers, employees, agents and representatives from and against all claims, liabilities, damages or causes of action arising out of or in connection with the player's participation in the program including, without limitation, player's transportation to/from any program, which transportation is hereby authorized.
I also consent that I have read and understood the Code of Conduct.
Do you agree with the terms? *
---Y X-SmallY SmallY MediumY LargeY X-LargeAdult SmallAdult MediumAdult Large
* are mandatory fields
African Canadian Soccer and Cultural Association (ACSCA)
#208 - 14888 104 Ave
Surrey, BC, V3R 1M4
10029 Whalley Blvd
Surrey, BC, V3T 4G1
Inku Gedecho – Youth Program Manager,
Africa United Youth Training Center
Tariku Tesfa – Program Assistant, Africa United Youth Training Center
Justin Ikwuegbu – Program Assistant, Africa United Youth Training Center
#208 – 14888 104 Ave
Surrey, BC, V3R 1M4