LFC Travel Registration

PLAYER INFORMATION (please fill in completely)

Player Name:*
Address:*
Player's Phone:
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Birthday:*
 / 
 / 
Age (as of 01/01/17):*
Uniform Size:

I voluntarily desire to play travel soccer for the Louisa Futbol Club (Louisa FC) a VYSA registered travel soccer club in Louisa County.

I understand that 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 Board.

I also understand the fee associated with the Summer/Fall Travel Season is $375 for 2017 Fall Travel Season. This payment is DUE in FULL and Payable on April 1, 2017 upon making and accepting the offer for a position on the team. Pay EARLY and receive a $25 discount off of the 2017 Fall Travel Season! You can Pay Online with our Pay Now button on the top right hand side page of our website. **Make sure you enter your Player's Name so to ensure proper payment is applied to your account** If you have multiple children playing you will have to do a separate registration form and separate payments for each child through the website. We do offer a sibling discount of $25 per sibling if more than one sibling is registered to play.

A complete kit will be provided to all new club players. Parents and players are reminded they are responsible for the purchase of any new LFC kit needed, sweat shirts, T-Shirts or travel bags. NOTE: Please take particular care of team kits and be sure to follow all specified washing/drying instructions. (Do Not Use Dryers or Irons on Kits/Sweats).

Any items loaned out to any parent or player (i.e. kits, sweatshirts or training items) must 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 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/tournament games until their account is made current.

LFC Agreement:*
PARENT/GUARDIAN INFORMATION (please fill in completely)
Parent/Guardian:*
Phone (home):
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Phone (cell):*
-
E-mail:
EMERGENCY INFORMATION: (please fill in completely)
Emergency Contact Name:*
Emergency Contact Phone:*
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Doctor:*
Doctor Phone:*
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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:*