LCF Oilers

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2021 OILER Player registration

ATHLETE INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

* Birthdate:

Email:

Gender:

Grade:

Requested Jersey number(not guaranteed):

PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

I understand that LCF is not responsible for incidental risks and hazards in his/her participation, including transportation
to and from all activities. I hereby waive, release, absolve, and indemnify not to hold any sponsors, officials, supervisors,
and other participants in any activities responsible. I acknowledge that LCF will not be responsible for any claim arising
out of the injury of the above named applicant whether the result of negligence or any other reason. We grant permission
to the supervisors, managing personnel, and other representatives the authority to obtain medical care from a licensed
physician; hospital or medical clinic should my son or daughter become ill or inured while participating in any activity when
neither parent nor guardian is available during the emergency. As the undersigned parent/guardian I do hereby grant LCF
my permission to obtain a copy of my son/daughter birth certificate, and recent photo. LCF also has the right to check with
the school and athletic department of my son/daughter school for the purpose of verifying his or her age and the legality to
participate in this program. I realize that changing of a birth certificate is forgery (falsifying a legal document), which is a state
and federal crime and also against league rules and policies. LCF will not tolerate such actions. All athletes are REQUIRED to participate fully in fundraising and parents are required to volunteer throughout the year. You have an option to buyout of our initial fdundraiser for the year by checking the box and buying out. Failure to complete any of these can/will result in player dismissal and negation of all rights as a member of the LCF Organization.

I/we agree with the above *

* indicates required fields

Initial fundraiser participation buyout($75)

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2021 OILER Player registration