Player Registration 2021

Payment
Payment Method*
- Credit/Debit Card (Online)
- Cheque (in person)
- Cash (in person)
- E-transfer Interac (email to vpadmin@gpkpackers.com)
Total Amount
$ 0.00 CAD
Credit Card*
MasterCard
Visa
Card Number Expiration Month/Year Security Code Cardholder Name
Email used for Interac eTransfer:*

Note: Please include the player’s name in the message field when sending the Interac eTransfer.
Jumpstart confirmation # (if applicable)
I confirm that I am 14 years or older
*
I consent to medical information being shared with medical partners, when necessary for the management of injury/health condition
*
I acknowledge the policies and my signature below indicates my consent
By signing below, you are authorizing the GREENFIELD PARK PACKERS Football Association to use photographs and/or video of you for the sole purpose of official GREENFIELD PARK PACKERS business (web site, newsletters, registration flyers, etc.). All photographs and/or video footage may only be taken during official GREENFIELD PARK PACKERS functions (practice, games, registration, etc.).

ALSO, YOU ARE CONFIRMING THAT THE SUPPLIED INFORMATION IS CORRECT AND YOU UNDERSTAND THAT, SHOULD YOU BE UNABLE TO ANSWER QUESTIONS PERTAINING TO YOUR HEALTH, THE FIRST RESPONDER WILL RELY ON THE SUPPLIED INFORMATION TO ASSIST YOU WITH YOUR AILMENT. In such a case your consent to assistance will also be implied.
Signature*
Use you mouse to create your signature or put your initials
Name of signee*
Payment completed
- Payment Received
- Payment Incomplete

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Player Registration 2021

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Step 1 of 3

Player Info

EMERGENCY CONTACT

ALTERNATE EMERGENCY CONTACT

PLAYER MEDICAL INFORMATION

Payment

gpkpackersfootball

2020 Registration