LFC Indoor Registration

PLAYER INFORMATION (please fill in completely)

Player Name:*
Address:*
Player Phone:
-
Birthday:*
 / 
 / 
Age (as of 12/1/16):*
Uniform Size:

I 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 fee associated with indoor soccer is $125 per player for the 2016-2017 indoor soccer season. This payment is due in full upon registration. I also understand that I must pay an additional membership fee of $10 directly to Fredericksburg Field House. Louisa FC will send out an additional email with instructions on the Membership process with Fredericksburg Field House once the teams have been setup. If you have multiple children playing indoor soccer you MUST complete an online registration for each child, complete with payment for each child. 

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. 

If payments are not received on time the player will be noted as being in "bad financial standing" with Louisa FC 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:*
PARENT/GUARDIAN INFORMATION (please fill in completely)
Parent/Guardian:*
Phone (home):
-
Phone (cell):*
-
E-mail:
EMERGENCY INFORMATION: (please fill in completely)
Emergency Contact Name:*
Emergency Contact Phone:*
-
Doctor:*
Doctor Phone:*
-
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:*
Amount ($125):*
 $