Fall 2018 Saturday Soccer Membership Form Full Name: __________________________________________________________________ Birth Date: ______/______/______ Gender (circle): M F School: _________________________________ Grade on Sept. 1, 2018 ____________ Last team this child played on: _____________________________________________ Coach or friend request: _____________________________________________________ Does this player also play LUFC travel or club soccer (circle)? Yes No Player #1 Please print clearly. Parent or Guardian Information Address: _____________________________________________________________________ City/State/Zip: _______________________________________________________________ Parent/Guardian Full Name: ____________________________________________________________________________________________________________________________________ Email: ________________________________________________________________________ Best phone # to reach you: __________________________________________________ Consent to Play and Waiver - parent or guardian must sign I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the Lakewood Soccer Association (LSA). Recognizing the possibility of physical injury associated with soccer and in consideration for the LSA accepting the registrant for its soccer programs and activities (the “Programs”), I hereby release, discharge and/or otherwise indemnify the LSA, their employees, associated per- sonnel and board members, including the owners of fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. Required Support Signature: _________________________________________________________ Date: ___________________ LSA is a volunteer organization. We require active participation of all members to keep fees down. Please check one area in which you can help. We always need coaches! Lindsay’s Law - Sudden Cardiac Arrest Lindsay’s Law - (Ohio Revised Code 3313.5310, 3707.58 and 3707.59) went into effect Aug 1, 2017 applicable to all youth sport organizations. All participants and their parents are required to view the video (16 minutes) and read the material contained at the following link: https://www.odh.ohio.gov/en/la nding/Lindsays-Law ‘Lindsay’s Law’ r By marking this check box, I, the parent/guardian of the participant, confirm that I have viewed the video and read the material regarding Sudden Cardiac Arrest contained in the above link. r By marking this check box, I, the parent/guardian of the participant, confirm that the youth participant has viewed the video and read the material regarding Sudden Cardiac Arrest. r Coach/Assistant Coach r Team Manager r Field Preparation/Set-up r Equipment Trailer Pulling r Concession Stand r Board Member Registration Deadline is July 31, 2018 Registration Fee Spring..................................................................$50 Late fee...............................................................$20 (if postmarked after July 31, 2018) LUFC players receive a 50% registration discount. Total Amount Paid $______________ Check # __________________ or Cash Make checks payable to Lakewood Soccer Assoc. Mail completed form and check to: P.O. Box 770701; Lakewood, Ohio 44107 Or drop off at: 1447 Lewis Dr., Lakewood, Ohio (attn: Registrar) After deadline, registrations will be taken with a $20 late fee. There are NO TEAM REQUESTS after the deadline. Register with check or cash with this form, or register with credit card at www.lakewood-soccer.com Full Name: __________________________________________________________________ Birth Date: ______/______/______ Gender (circle): M F School: _________________________________ Grade on Sept. 1, 2018____________ Last team this child played on: _____________________________________________ Coach or friend request: _____________________________________________________ Does this player also play LUFC travel or club soccer (circle)? Yes No Player #2 (If you are registering more than two children, please use an additional form.) Team Assignment Notification: the Week of Aug 17 Schedule of 8 Games will Begin Aug. 25 Uniforms can be purchased at Geiger’s More information at www.lakewood-soccer.com