LFC Indoor Registration PLAYER INFORMATION (please fill in completely)Player Name:* First Last Address:* Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodePlayer Phone: Area Code - Phone Number Birthday:*01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 2015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901daymonthyearAge (as of 1/01/20):*Uniform Size:Select valueYMYLASAMALAXLAXXLI voluntarily desire to play indoor soccer for the Louisa Futbol Club (Louisa FC).I understand that signing (includes electronic submissions and or electronic signatures) the form binds me to the above named team for the indoor season.unless of medical injury (in which proper documentation must be provided).I also understand the (non-refundabale) fee associated with indoor soccer is $150.00 per player for the 2020-2021 indoor soccer season. This payment is due in full upon registration. MUST complete an online registration for each child participating. Any items loaned out to any parent or player (i.e. kits, sweatshirts or training items) must be returned in the same condition of which it was received; except for normal wear and tear. Any Lost or damaged gear will be replaced at the users expense.If payments are not received on time the player will be noted as being in "bad financial standing" until such time that the fees are paid. A player in this status may not be allowed to train with their team or play in any games until their account is made current. LFC Agreement:*I AgreePARENT/GUARDIAN INFORMATION (please fill in completely)Parent/Guardian:* First Last Phone (home): Area Code - Phone Number Phone (cell):* Area Code - Phone Number E-mail:EMERGENCY INFORMATION: (please fill in completely)Emergency Contact Name:* First Last Emergency Contact Phone:* Area Code - Phone Number Doctor:* First Last Doctor Phone:* Area Code - Phone Number Hospital Name:Insurance:I understand that signing this form binds my son/daughter to the Louisa Futbol Club (Louisa FC) for the Indoor Season unless of medical injury (in which proper documentation must be provided).I hereby give my consent and approval for my son/daughter to participate in this activity sponsored by Louisa FC. I will not hold association members, coaches, or volunteers responsible in case of accident or injury as a result of my child’s participation in this program.I understand the risks involved with this activity and know that my child is physically able to participate in this program.In the event of an emergency, I hereby give my consent for a representative of Louisa FC to arrange for medical or emergency room treatment by a physician on staff.LFC Medical Agreement:*I AgreeAmount ($150.00):* $ . DollarsCentsSubmitReset
