LSC Player Registration Form

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Team *

U10 Girls

U10 Boys

U12 Girls

U12 Boys

U14 Girls

U14 Boys

U16 Girls

U16 Boys

U19 Girls

U19 Boys

Required

Does your player own one blue and one gold Lansing Soccer Club uniform? *

Yes

If the player has a set of jerseys to wear this Spring, what number will the player be wearing?

Player's Last Name *

Player's First Name *

Middle Initial *

Address *

Home Phone (000) 000-0000 *

Player Email *

Birthdate (mm/dd/yyyy) *

Gender *

Male

Female

Other:

Grade in school *

Guardian #1 Name *

Guardian #1 Cell (000) 000-0000 *

Guardian #1 email *

Guardian #2 Name

Guardian #2 Cell (000) 000-0000

Guardian #2 email

Emergency Contact Name (Not a parent) *

Emergency Contact Relationship *

Emergency Contact Cell (000) 000-0000 *

Physician *

Physician's Telephone (000) 000-0000 *

List any medical problems we should know about.

I, the legal guardian of the applicant, agree that the applicant (player) and I will abide by the rules of the LANSING SOCCER CLUB, INC., its affiliated organizations and sponsors. As a fan of soccer, I recognize that youth players are developing and as such need encouragement and learn best from my good example. I agree to never criticize the applicant's performance at any time. I agree to never make any comments (verbally or otherwise) about the officiating and to make any comments to the coach after the game. I recognize that poor behavior on my part may result in a red card being give to the coach by an official of the game whether I am on or off the field, watching a game or not. A red card will cause the coach to be removed from the game, fined, and will have to appear at a hearing. Please type your name below. *

I, the legal guardian of the applicant, recognizing the possibility of physical injury associated with soccer and in consideration for The Club accepting the applicant for its soccer programs and activities, hereby release, discharge, and/or otherwise indemnify The Club, its affiliate organizations and sponsors, their employees by or on behalf of the applicant as a result of the applicant's participation in the programs and/or being consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry.This care may be given under whatever conditions are necessary to reserve life, limb, or well-being of my dependent. I accept responsibility for payment for any such services provided. Please type your name below. *

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