Quebec Recreational Soccer League

Username

Email

User

Birthday *

Medicare Number *

Medicare Picture *

Take a clear picture of your medicare card

Emergency Contact Person *

Emergency Contact Phone *

Image *

* IMPORTANT : You have to submit a clear image of your FACE only.

Waiver *

• While participating in the Quebec Recreational Soccer League, I acknowledge and agree that the risk for serious injury exists. I knowingly and freelyassume all such risks and assume full responsibility for my participation. I have read and agree to comply with the rules and guidelines mentioned inthis manual and on qrsl.ca. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESSQuebec Recreational Soccer League their officers, officials, agents and/or employees, and all those associated with QRSL for the said event, with respect to any and all injury, disability, death, or loss or damage to person or property, whether caused by the negligence of the releasees or otherwise.I have read this release of liability in english, fully understand its’ terms and sign it freely and voluntarily without inducement.

First Name

Last Name

Club
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Registration confirmation will be emailed to you.