Eureka Junior League Football and Cheer

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Eureka Junior League Football & Cheer Registration 2025

PLAYER INFORMATION

New Player

Returning Player

* First Name:

* Last Name:

Cheerleader

Football Player

* Primary Address (2 utility bill verfications required):

City:

Zip Code:

* State:

Home Phone:

* Birthdate:

* Age as of August 31st:

Email:

Gender:

* School Fall, 2025:

* Grade Fall, 2025:

PARENT/GUARDIAN #1

Firstname:

* Lastname:

* Address:

EMail:

Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

* Address:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

* Relationship to Player:

Doctor:

Insurance Carrier:

Doctor's Phone Number::

Policy #:

NO REFUNDS

I/we agree with the above *

* indicates required fields

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Eureka Junior League Football & Cheer Registration 2025