Academy Registration - Lansing City Futsal

Winter Youth Club Registration Form

Academy Registration

Parent/Legal Guardian Name

Parent/Legal Guardian Phone #

Email to be used for all communication

Email #2

Secondary Email To Be Used Additionally, If Desired

Player Name

Player's Date of Birth

Use Format mm/dd/yyyy
(I know we ask for your Birth certificate, but this makes our job 1000% easier, so we can spend more time on what we love, futsal!)

Player Phone # (if applicable)

Home Address

Street Address

City

Country

Enter your full address so that we can ship to you.

Attach Birth Certificate

Attach Photo Of Birth Certificate

Attach Player ID

Attach Photo Of USYF Player Card Or Other Photo ID, Such As Driver's License Or Student ID

Waiver Agreement

This agreement releases Lansing City Futsal from all liability relating to injuries that may occur during participation in Lansing City Futsal activities.

By signing this form, I agree to hold Lansing City Futsal entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence.

I also acknowledge the risks involved in Lansing City Futsal activities. These include but are not limited to Futsal related injuries. I swear that I am participating voluntarily, and that all risks have been made clear to me. Additionally, I do not have any conditions that will increase my likelihood of experiencing injuries while engaging in this activity.

By signing this form I forfeit all right to bring a suit against Lansing City Futsal for any reason. In return, I will receive the opportunity to participate in Lansing City Futsal’s activities. I will also make every effort to obey safety precautions as listed in writing and as explained to me verbally. I will ask for clarification when needed.

I fully understand and agree to the above terms.

Emergency Phone #

In case of an emergency we will call this number

Signature

Signature Of Parent/Legal Guardian If Under 18

Name of Doctor

Please enter the name of the player's doctor, in case of a medical emergency.

Payment

Discount

Subtotal

Tax

Total USD