Chilliwack Power Soccer Registration form 2018
Chilliwack Power Soccer will be taking place on Friday's 3:00pm - 4:30pm at Vedder Middle School on the following dates: October 26th, November 2nd, November 9th, November 16th, November 23rd and will return back in the Spring: April 5, April 12th, April 26th, May 10th, May 24th, and May 31st.

Transportation from the participants school can be provided. However, parents or guardians are responsible for pick up at 4:30pm. All equipment and program facilitation will be provided by SportAbility and SD33.

There is no registration cost for this program. However, all participants must be 2018/2019 (valid April 2018 - April 2019) members of SportAbility ($10.00 Recreational Membership).

Please contact Jade: jadewerger@sportabilitybc.ca if you are unsure of your membership status. For new members, our membership form is attached at the bottom of this registration form. Please complete all of the questions below if you are interested in registering for this program.

Participant Name *
Your answer
Participant Birthdate *
MM
/
DD
/
YYYY
Contact Email *
Your answer
Contact Phone Number *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Physical / Health needs of the participant (eg. toileting, seizure, allergies etc. ) *
Your answer
Has the participant participated in power soccer before? *
Participants School Name *
Your answer
Does the participant require a ride to the venue? (please note: SD33 will be arranging transportation via wheelchair accessible taxis to transport participants from their school to Vedder Middle School. However, parents/guardians are responsible for pick up arrangements at 4:30pm). *
Will a parent / guardian be attending the sessions with the participant or will the participant require an attendant (EA)? (provided by SD33) *
Will the participants power chair need to be transported back to the school after each session? (arranged by SD33)
Are you currently a member of SportAbility for the 2018-2019 season?
Participants from must be a current member of SportAbility to participate in the program.
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.