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(1.6 km), turn left at Orleans Boulevard (0.4 km) to 975 Orleans BoulevardSaturday May 8, 2010Sunday May 9, 2010$REFEREE MINI COURSE APPLICATION FORM Uniform Size (if required)Jersey (Adult)SmallMediumLarge Extra LargeShorts (Adult)SocksYouthAdultRequired to referee U8 to U109:00 am to 4:00 pmCheque EnclosedWaiver Attached"referee for Dragons and/or Hornetsc)8**Special Note for Returning OSA Certified Mini Refereesab3New Dragons/Hornets Mini Referee requiring full kit  jYou will only need to attend a portion of the full course. These special courses will be held on May 9th.ee)}You will also be required to attend an overview course (no charge), please complete a registration form for this course also. OSA Number: NEW RefereeRETURNING OSA Certified Referee  R-2010-017:00 p.m. to 9:00 p.m. R-2010-02 R-2010-03$Overview Course - required - NO COSTIReturning OSA Certified Dragons/Hornets Mini Referee NOT requiring kit ** 58 G 0Dragons Soccer Club,1-5510 Canotek Road, K1J 9J4,Cairine Wilson School, 975 Orleans BoulevardM-2010-01 - NEW REFSM-2010-02 - RETURNING REFSTuesday, May 4Thursday, May 6Wednesday, May 12Prov:ONTARIO SOCCER ASSOCIATIONReferee Registration Form=For participants of Entry Level or Mini Soccer Referee Course$For Participants UNDER THE AGE OF 18=This form is to be retained by the host of the referee course2Name of Referee: _________________________________3Date of Birth: ____________________________________'CONSENT FOR USE OF PERSONAL INFORMATIONI authorize The Ontario Soccer Association to collect and use personal information about me or my child/ward for the purpose of receiving communications from the Canadian Soccer Association, Ontario Soccer Association, District Association, League and Club.gI understand that I may withdraw such consent related to receiving communications at any time by contacting the OSA Privacy Officer at OSAPrivacyOfficer@soccer.on.ca or by mail to: Attention: OSA Privacy Officer, The Ontario Soccer Association, 7601 Martin Grove Road, Vaughan ON, L4L 9E4. The Privacy Officer will advise the implications of such withdrawal.l**The OSA does not sell or distribute your personal information to any other third party not listed herein**Printed Name of Participant Signature of Participant Date of Birth"Printed Name of Parent or Guardian%Signature of Parent or Guardian !_________________________________QReferee s Agreement to Participate (To Be Used for Referee s Under the Age of 18)>ALL PROGRAMS AND ACTIVITIES INCLUDING REFEREEING HAS ITS RISKS$I AGREE TO BE RESPONSIBLE FOR MYSELF #I ACKNOWLEDGE MAKING THIS AGREEMENThRegistration of the referee is for both indoor and outdoor soccer during the timeframe specified in 1.2.$Registration on this form entitles you to referee sanctioned soccer games in the Province of Ontario. This includes tournament games, exhibition games, cup games, and league games. As per OSA policy, registered referees are responsible to ensure games are sanctioned prior to officiating. Registered referees officiating sanctioned games involving players on registered teams, are covered under the OSA Insurance Programme (both accident and liability) and the OSA Discipline Programme. Registered referees officiating either unsanctioned games, unregistered players, or unregistered teams, are not covered under the OSA Insurance Programme, but will be subject to the OSA Discipline Programme.aNotwithstanding 1.4 above, registered referees may referee school, college, and university teams.This Registration Form is only to be used by first-year referees, under the age of 18, who are attending an OSA-sanctioned Entry Level or Mini Soccer Referee Course.BURegistration is effective upon successful completion of the Entry Level or Mini Soccer Referee Course, validated by the OSA, and is effective up to and including March 31st, 2010.You and a parent/guardian must sign the registration form before it can be processed. By signing the form, you are stating that you have read and understand the registration rules and you are agreeing to abide by the Published Rules and Policies of The Ontario Soccer Association. In addition, you are verifying that all the information is accurate and any falsifying or withholding of information may result in disciplinary action.Copies of the OSA Published Rules have been distributed to your District Association and are available on the OSA website at www.soccer.on.ca.1.0 General Information 2.0 Signature of Referee I participate and referee in the game of soccer because it is physically and mentally challenging. In consideration of my participation as a referee in such programs, activities and events, I hereby acknowledge that I am aware of the risks and hazards associated with or related to refereeing soccer programs, activities and events. The risks and hazards include, but are not limited to:b)c)d)e)f)g)h)i)IGrass, turf and other surfaces including bacterial infections and rashes;EFalling to the ground due to uneven or irregular terrain or surfaces;9Collisions with walls, soccer equipment and soccer goals;hFailing to properly use any piece of equipment or from the mechanical failure of any piece of equipment;TExtreme weather conditions which may result in heatstroke, sunstroke or hypothermia;bAccidental or unintentional contact, collision or being struck by other participants or equipment;AVigorous physical exertion and strenuous cardiovascular workouts;2Exerting and stretching various muscle groups; andTravel to and from competitive events and associated non-competitive events which are an integral part of the Organization s activities.Furthermore, I am aware:;That injuries sustained in soccer refereeing can be severe;{That I may come into close contact with other participants, including the possibility of accidental and unexpected contact;mThat I may experience anxiety while refereeing during the programs, activities or events of the Organization;YThat my risk of injury is reduced if I follow all rules adopted by the Organization; and 6That my risk of injury increases as I become fatigued.I have read and understood the terms and conditions of this agreement, and by signing it voluntarily, I am agreeing to abide by these terms. I am participating voluntarily as a referee in these activities, events and programs of the Organization. < I agree that there are risks in refereeing soccer as described above. By participating voluntarily in these events, activities and programs, I am exposed to these risks and hazards. I agree to accept them and be responsible for any injury or other loss which I might receive while refereeing in these events, activities and programs.# If something happens to me, I release the Organization of responsibility for any claims, demands, actions and costs which might arise out of my participation and caused by the risks described herein. 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