LFC Travel Registration – Louisa Futbol Club

PLAYER INFORMATION (please fill in completely)

Player Name:*

First

Last

Address:*

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip Code

Player's Phone:

Area Code

Phone Number

Birthday:*

day

month

year

Age (as of 01/01/22):*

Uniform Size:

I voluntarily desire to play for Louisa FC a USYS and VYSA affiliated travel soccer program located in Louisa, VA.

I understand that by signing (includes electronic submissions and or electronic signatures) the form binds me to the above named team for the entire seasonal year (summer/fall/winter) unless of medical injury (in which proper documentation must be provided) or request for transfer is approved by the Louisa FC Director.

I also understand the fee associated with the 2022 Fall Travel Season is $500.00. All payments are due on or before July 4th, 2022. We do offer a sibling discount of $25 per sibling if more than one sibling is registered to play.

Alternative Paymet Method: We do offer cash or check paymets. Please make checks out to... Louisa FC and write the "players" name in the comments* Thank You!

Kits will be provided for all new players. New kits will be ordered as needed of when life cycle of item/product ends. Therefore returning players may not receive a completely new kit each season.
LFC will order any kit items needed for returning players, prior to the begining of each season.
Parents and players are reminded they are responsible for the kit replacement if lost, stolen or damaged off the pitch during the season.
LFC gear, such as sweat shirts, T-Shirts or travel bags can be ordered at the LFC store at an additional cost.
Please take particular care of your LFC gear and be sure to follow all specified washing & drying instructions. (Hand washing is best and Do Not Use dryers or irons on kits & sweats).
Any items loaned out to parent or player (i.e. kits, sweatshirts or training items) must be returned in the same condition of which it was received, or you will be resposible for the replacement of that item.

If payments are not received on time the player will be noted as being in "bad financial standing" with the club 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 league or tournament matches until their account is made current.

LFC Agreement:*

I Agree

PARENT/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 Travel 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 (LFC). 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 Agree