LYF

2012 Football Player Registration Form
Fees: $150 per player
$5 additional if paying by credit card
$15 discount for each additional Football player

LAST DAY TO SIGN UP AND BE GUARANTEED A SPOT ON A TEAM IS APRIL 1, 2012.
LATE FEE MAY BE ASSESSED AFTER APRIL 1.

Player Information

First Name:

Last Name:

Date of Birth
(mm/dd/yyyy):

Age:

Address:

City:

State:

Zip:

Current Height :
feet inches

Current Weight :
pounds

Home Phone:
(555-555-5555)

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

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

Email:

Please Confirm Email Address:

Your Coach Last Year:

Your Jersey Number Last Year:

Grade 1 - Open
Grade 2 - Open
Grade 3 - Open
Grade 4 - Open
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:

Phone:
(555-555-5555)

Doctor:

Phone:
(555-555-5555)

List any known medical problems the player has:

Payment Information

I have already registered one child and paid the full registration fee. This registration is therefore entitled to the $15 sibling discount.
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 2 hours, per participant, of volunteer work during your team's home game dates. Please read our Parental Volunteer Pledge and indicate your willingness to help.
	I understand that Loveland Youth Football is a volunteer organization and needs my help. I pledge my family's help when called to work at home games (concessions, gate, clean-up).
Are you interested in volunteering as a: Coach Assistant Coach Team Rep
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.
CONSENT FOR MEDICAL TREATMENT (Minor)
	As Parent or Legal Guardian of the above named player, 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.

LYF REFUND POLICY

If football player resigns between registration and July 1st, refund is $100.

If player resigns between July 1st and Preview Games, refund is $75.

Refund amounts will be adjusted for siblings in the event a sibling discount was taken.

No refunds after Preview Games.

LYF must be notified through an email via the website, or contact with an executive board member (www.lovelandyouthfootball.com).

Accept Credit Cards

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