JR. LIONS CHEERLEADING

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2012 Birth Year Registration

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Phone Number:

* Birthdate:

* Grade in September 2026:

* Gender:

PARENT/GUARDIAN #1

* First Name:

* Last Name:

* Email:

Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

First Name:

Last Name:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

* Insurance Carrier:

* Policy #:

* Allergies/Medical Information::

OTHER

I understand my child will be attending Pine Forest sleepaway camp as part of this team (August 15th-18th)

I understand my child will be part of the Game Day Team (2nd routine) as part of this team

* Are you interested in becoming a team parent?:

Yes

* I /We GRANT permission for my child(ren)'s photos/images to be used on Jr. Lions Facebook, the BAND app or Website.:

Yes

Anything else you'd like us to know?:

All above information is correct *

* Parent, Guardian or Adult E-mail:

* indicates required fields

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2012 Birth Year Registration