Texarkana Jackals

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Jackal try-out application

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Are you able to make weekly practices and games on Saturdays?:

Pimary Position:

Secondary Position:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

*** This is a contact sport. If serious injury occurs to me while practicing, playing, or riding to a game, I will hold the Texarkana Jackals blameless and not pursue legal remedies for injuries sustained to myself ***

I/we agree with the above *

* indicates required fields

IMPORTANT: Online Payment with credit cards is not active for this form

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Jackal try-out application