Welcome to Nanaimo City FC

Registration

Free soccer for youth. Building community, culture, and connection.

Check eligibility by clicking here.

Complete the form below and sign the digital waiver.

Wait to hear from our team of volunteers.

Register Your Child

This section is for the parent or guardians contact information.

First name

Last name

Phone

Address

Second emergency contact First and Last Name

Second emergency contact phone number

Information about the child

If you would like to register multiple children, please fill out this form once for each child being registered.

Childs Full Name

Childs Age

If there are any health conditions, please explain

Are their any activity restrictions?

Yes

If there ARE activity restrictions, please explain:

I, undersigned, agree with the following statements:

Medical Release: Between starting and ending of the event, as deemed necessary, I authorize activity holder to select the hospital or dentist for hospitalization, to secure proper treatment, and/or order an injection, anesthesia, or surgery for the person specified above.

Liability Release: Even with the best of planning and precaution, unforseen events can occur. By signing this form, I agree to assume and accept all risks and hazards inherent in the activities. They also agree not to hold activity holder or its employees or volunteer assistants liable for damages, losses, or injuries to the person or property undersigned.

Date

Year

Month

Day

Signature

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