LYF

2012 Football Cheerleading Registration Form
Fees: $50 non refundable registration fee due at time of registration.
$5 additional if paying by credit card
$75 Jacket Deposit to be paid at Uniform Fitting, not at registration.

GUARANTEE YOUR POSITION ON A SQUAD AND REGISTER BY APRIL 1, 2012.
(LATE FEE MAY BE ASSESSED AFTER APRIL 1, 2012)

Cheerleader Information

First Name:

Last Name:

Date of Birth (mm/dd/yyyy):

Address:

City:

State:

Zip:

Mom's Name:

Mom's Cell Phone:
(555-555-5555)

Dad's Name:

Dad's Cell Phone:
(555-555-5555)

Email:

Please Confirm Email Address:

Home Phone:
(555-555-5555)

Your Coach Last Year:

Grade 1 - CLOSED
Grade 2 - CLOSED
Grade 3 - CLOSED
Grade 4 - CLOSED
Grade 5 - CLOSED
Grade 6 - CLOSED

Current Grade:

Grade Next Year (in Aug 2012):

If you do not see your grade listed, then that grade is full.

L.Y.F. is required to report residency. Please check the item that indicates your residence:

Loveland City Limits
Miami Township
Symmes Township
Other - Please Specify:

Live within the Loveland School District?
Yes No

In case of Emergency notify:

Person:

Relation:

Phone:

(555-555-5555)

Doctor:

Doctor Phone:
(555-555-5555)

Dentist:

Dentist Phone:
(555-555-5555)

List any known medical problems:

CONSENT FOR MEDICAL TREATMENT (Minor)
	As Parent or Legal Guardian of the above named cheerleader, I hereby give my consent for emergency medical treatment prescribed by a duly licensed doctor of medicine. This care may be given under whatever conditions are necessary to preserve the life, limb, or well being of my dependent.

Payment Information

Fee:	$
How Would You Like to Pay for this Registration?	Check/Cash Credit Card

Credit Card Information

Type of Credit Card:	Visa Master Card
Credit Card Number:
Expiration Date:	/
Card Holder Name:
Card Holder Address:
Card Holder Zip:
CSV Code (on back of card):

Parents: We must have your support and participation in our program. Each family should be prepared to contribute a minimum of 4 hours, per participant, of volunteer work during your team's home game dates working in the concession area, gate or clean up rolls. You may also want to further your participation by coaching, helping as a team mom, cheer activity coordinatioin or homecoming volunteer. Your help is also vital to our annual cheer competition. Regardless if your child's squad competes your help is required and desperately needed to run a successful fundraiser and competition eacy year.
I would be interested in volunteering as a: Coach Assistant Coach Team Parent
WAIVER AND RELEASE OF LIABILITY
	I, the parent or the legal guardian of and on behalf of the registrant and myself, do for ourselves, our heirs, executors and administrators, agree to hold harmless and agree to indemnify the Loveland Youth Football organization, Member Leagues, Member Clubs, Officers, Officials, Coaches, Referees, Managers, Owners of Football fields, and the facilities utilized, or any Sponsors for any claim that might be asserted by us or our child as a participant in the game of football. I do hereby authorize the officers, Leaders, Coaches, Agent(s) of the youth organization and or affiliated members to transport as required, the above Minor to and from organization sponsored activities, including, but not limited to, athletic and social events.

LYF CHEERLEADER REFUND POLICY
· No Cheerleader refunds.

Accept Credit Cards

Loveland Youth Football
PO Box 694
Loveland, OH 45140
For questions about registration, please contact Jim Pecot at info@lovelandyouthfootball.com