Fortius Sport & Health
Burnaby, B.C.
info@romantulis.ca
604-937-0500

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Full Time Program

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Full Time Registration Form

Please complete this registration form in full.
All fields marked with * are required.

Player Information

Name:*
Gender*
Birthday:*
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Home Phone Number:*
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If we need to reach you by phone on a training day, the best number to leave a message would be: *
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Address:*

NOTE: E-mail is used for all communications such as memos & training changes.

Please make sure the e-mail address below is checked on a regular basis.

E-mail:*
NOTE: only include a second email if you absolutely MUST have information sent to more than one person.
Second E-mail:

Family Information

Name of Father:*
Cell Phone Number - Father:
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Business Phone Number - Father:
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Name of Mother:*
Cell Phone Number - Mother:
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Business Phone Number - Mother:
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Emergency Contact Name:*
Emergency Phone:*
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If you require a tax receipt for your training who do we make the receipt out to?
Who would you like the tax receipt to be e-mailed to?

Additional Information

Current Club Team:
Currently or in the past has player trained with any other soccer program than club team:
If yes, what program?

£  Liability Waiver*   

By indicating your acceptance you acknowledge the above-named registrant and the parents/guardians hereby agree that the European Soccer School of Excellence will not be held responsible for any accident or loss no matter how it is caused, and agree to release all instructors, staff or sponsors from all claims or damages which may arise as a result of/or by reason of such accident or loss.*

£  Image Rights Waiver*

By indicating your acceptance you understand and agree that the Roman Tulis staff may take photographic or video images of the above-named registrant. You further grant the Roman Tulis School the right to use such image or likeness in all forms and media, in connection with promotion of our program, or the sport of soccer generally.*

By indicating your acceptance you acknowledge you have read and understand our policy regarding leaving the program. Should you wish to leave the program you MUST give us one month written notice. Example if you are planning to leave the program on May 1st we would need to receive notice from you by or no later than March 31st. Earlier would be better as there may be someone waiting for a spot in your group and we would like to notify them as soon as we can. Once again, using the example above, if your notice is received later than March 31st, you will be paying for both April and May and your final training day would be May 31st.*

IMPORTANT: Before submitting this form, please verify that all information provided is correct and up-to-date.*
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