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2016 Birth Year Registration
PLAYER INFORMATION
*
First Name:
*
Last Name:
*
Street:
*
City:
*
State:
*
Zip Code:
*
Phone Number:
*
Birthdate:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
*
Grade in September 2026:
K
1
2
3
4
5
6
7
8
*
Gender:
Female
Male
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'd like to add on Pine Forest sleepaway camp to my registration (August 15th-18th) - optional for this age group:
Yes
No
I'd like to learn more
*
I'd like to add Game Day Team (2nd routine) to my registration - optional for this age group:
Yes
No
I'd like to learn more
*
Are you interested in becoming a team parent?:
Yes
No
*
I /We GRANT permission for my child(ren)'s photos/images to be used on Jr. Lions Facebook, the BAND app or Website.:
Yes
No
Anything else you'd like us to know?:
All above information is correct
*
*
Parent, Guardian or Adult E-mail:
* indicates required fields