SRL: Outdoor Sign-Up Sheet

Complete this form if you would like to be placed on the Burlington Senior Recreational League waiting list. You must be 35 years or older in 2009 and you must reside in the Burlington area (at least 50% of a team's players must reside in the City of Burlington).

If you meet these conditions, you will be placed on a waiting list and you will be contacted as places become available.

First Name: Middle Name:
Last Name:
Street Address: Apt. No:
City/Town: Postal Code:
Date of Birth: day month year
Home Tel: - - Work Tel: - -
Fax: - -
E-mail address:
(Boxes in Blue Text must be filled)

Have you played soccer before?
Never A little Used to play frequently Still play frequently

Highest level at which you have played
None House School Rep. Open Age Recreational Semi-professional Professional

Position most frequently played
None Goalkeeper Defence Midfield Forward

Are you presently registered with another team/league?
Yes No
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