WINKLER AMATEUR SOCCER ASSOCIATION

2015 REGISTRATION FORM

Please read carefully!
I

NAME:
MALE

FEMALE

Parent(s)/Guardian(s):
DATE OF BIRTH
Grade

School:

/_
/
Day / Mo / Yr
(for Fall 2015)

Resident of: Winkler

RM of Stanley
Other_
Phone:

(home)

(cell)

*E-MAIL (important for contact from coach):

Emergency contact during game:
(phone) MB Health Reg #:

(name)
Personal Health ID#:

SOCCER HISTORY: The objective of the WASA Executive is to make fair and balanced teams
so that soccer can be fun for everyone. To help us create fair teams please provide the
following information:
1.Has your child played minor soccer previously? NO
2. Rate your childs athletic ability

YES - # of years

1(not athletic) 2

5 (very athletic)

3. Does your child play for the Winkler Wild? Yes or No

4. Does your child have any medical concerns?
5. Does your child have any learning/behavioral concerns?
Special Requests (may or may not be able to be honored) Please indicate it here:
CONDITIONS:
1. REGISTRATION FEE - $35 must accompany this form. (See refund policy)
2. LATE REGISTRATION additional $35 late fee in effect after this date. Registrations
will not be accepted after May 30.

VOLUNTEERS NEEDED: Check off areas willing to assist:

Executive Coach

Assistant/Substitute Coach

First Night/Last night tasks

Would your child (in grade 4-8) be interested in playing competitive spring soccer with the Winkler
Wild in 2016? (Not apart of WASA)
NO
YES

IF you check yes you may be contacted in spring.

PARENT/GUARDIAN CONSENT:
MEDICAL WAIVER
I, the parent/guardian of the above named child, hereby give
my approval to his/her participation in all Amateur Soccer
Association activities during the current season. I assume all risks
and hazards incidental to such participation, including transporting
to and from activities. I understand that the Winkler Amateur
Soccer Association is not liable for any injuries sustained by my
child or any loss or damage to his/her property as a result of my
childs participation in the soccer program. I, for myself, my heirs,
executors, administrators and assigns release, absolve, indemnify
and agree to hold harmless the Winkler Amateur Soccer
Association, the organizer, participants and persons transporting
my child, except for the extent covered by accident or liability
insurance. I hereby grant permission to any of the persons
involved in the above-mentioned organization to obtain medical
treatment should such treatment be required.
Parent/Guardian Signature:

Date:_

Please initial the following giving permission for its use:

I, the parent/guardian CONSENT for WASA to use
pictures of my child for a Team Photo.
I, the parent/guardian CONSENT for my childs
name to be posted on team lists on the website.
WINKLER AMATEUR SOCCER ASSOCIATION

PLEASE READ CAREFULLY

Game Schedules will be listed on website at www.winklerminorsoccer.org
Co-Chair: Werner Dyck & Wes Harder Treasurer: Sharlene Neisteter

Equipment Manager: Vlad Bleznuk

Coaching/Training: Werner Dyck Website: Christina Wall
Jerseys: Karina Bueckert
Team Photos: Ang Harder
Conveyors:
K/1 boys and girls: Sarah Klos
2/3 girls: Kenton Doerksen
2/3 boys: Gwen Ginter
4/5 girls: Katherine Enns
4/5 boys: Tammy Wall
6/7/8 girls: Leanne Dyck
6/7/8 boys: Pete Peters
Check website mid- August for team information. The coach should contact you to introduce
themselves and remind you of your first session the week before soccer begins!
SCHEDULE: First Night Tuesday, September 1st, 2015 until October 1st, 2015
Sessions are from 6:30 7:30 on Tuesday & Thursday.
All schedules will be posted on www.winklerminorsoccer.org
Please have your child at soccer on time and prepared for practice. A labeled water
bottle is recommended.
CANCELLATIONS:
WASA will not formally cancel soccer practices. Parents can use their discretion. There will be no
Soccer if there is lightning.
REFUND POLICY:
Please note the following:
If prior to the season $5 is charged and subtracted from the registration fee.

Once the season has started a refund will not be issued.

Due to medical circumstances a refund may be requested.

Parent Volunteers:
Winkler Amateur Soccer Association (WASA) is a volunteer run club and we require parent
volunteers to be coaches, asst. coaches, and team managers. No experience is necessary. The club
provides a coaching clinic, manual and online resources to support our coaches. If you wish to
volunteer to coach or manage your childs team, please indicate during the registration process.
If you wish to help as a convenor, equipment manager, photos or in another admin capacity, please
contact the WASA Chairperson at www.winklerminorsoccer.org.

Please check website for policies, code of conduct for parents & players, soccer rules,
field & game schedules, and team lists.