Cowgirl Cheer and Dance Athletics

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2017-2018 Registration Application

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

* Experience:

New Athlete - New to Cheerleading

New Athlete - New to CCA

Returning Athlete - Returning to CCA

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 this is only the initial registration application. Registration will not be complete/finalized until all necessary forms are completed and signed where necessary and any registration fees due are paid in full.

I am authorizing Cowgirl Cheer Athletics to contact me to complete the registraion process *

* indicates required fields

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2017-2018 Registration Application