LCOC Sports Registration Form This is the registration form for LCOC. Step 1 of 3 33% Registration TypeNew MemberRenewalApplicant's InformationParticipant Name/Child Name(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Age(Required) Sex(Required) Male Female Has your child been identified or diagnosed as having a special need?(Required) Yes No Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Email(Required) School Attending(Required) Grade(Required) School ID Number In case of emergency: Contact Name(Required) First Last Phone(Required)Relationship to applicant(Required) Parent/Guardian InformationWhich parent Information you want to fill?(Required) Mother Father Mother/GuardianName(Required) Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone - Home(Required)Phone - WorkOccupation Email Registered Voter Yes No Father/GuardianName(Required) Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone - Home(Required)Phone - WorkOccupation Email Registered Voter Yes No Consent(Required) PHYSICAL EXAMINATIONI certify that within the past 12 months my child has had a physical examination by a physician and that he/she is physically able to participate in sporting activities.Consent(Required) I understand that by signing this agreement I am giving up certain legal rights, including the right to sue or claim compensation following injury, loss, or damage to person or property arising out of my participation in the activity.Consent(Required) PARENT OR LEGAL GUARDIAN CONSENT (required for participant under 18 years old)As Participant's parent or legal guardian, I agree to the terms of this Agreement and consent to Participant's participation in the Activity.Sports(Required) BASEBALL BASKETBALL FOOTBALL CHEERLEADING SOCCER / SUMMER EDUCATIONAL/CULTURAL DANCE VOLLEYBALL FLAG Product NameTotal Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.
LCOC Sports Registration Form This is the registration form for LCOC. Step 1 of 3 33% Registration TypeNew MemberRenewalApplicant's InformationParticipant Name/Child Name(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Age(Required) Sex(Required) Male Female Has your child been identified or diagnosed as having a special need?(Required) Yes No Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Email(Required) School Attending(Required) Grade(Required) School ID Number In case of emergency: Contact Name(Required) First Last Phone(Required)Relationship to applicant(Required) Parent/Guardian InformationWhich parent Information you want to fill?(Required) Mother Father Mother/GuardianName(Required) Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone - Home(Required)Phone - WorkOccupation Email Registered Voter Yes No Father/GuardianName(Required) Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone - Home(Required)Phone - WorkOccupation Email Registered Voter Yes No Consent(Required) PHYSICAL EXAMINATIONI certify that within the past 12 months my child has had a physical examination by a physician and that he/she is physically able to participate in sporting activities.Consent(Required) I understand that by signing this agreement I am giving up certain legal rights, including the right to sue or claim compensation following injury, loss, or damage to person or property arising out of my participation in the activity.Consent(Required) PARENT OR LEGAL GUARDIAN CONSENT (required for participant under 18 years old)As Participant's parent or legal guardian, I agree to the terms of this Agreement and consent to Participant's participation in the Activity.Sports(Required) BASEBALL BASKETBALL FOOTBALL CHEERLEADING SOCCER / SUMMER EDUCATIONAL/CULTURAL DANCE VOLLEYBALL FLAG Product NameTotal Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.
