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Football

Cheerleader

PLAYER INFORMATION

* First Name/MI:

* Last Name:

* Address:

* City:

* Zip Code:

* Home Phone:

* Age:(as of Aug. 1st):

* Birthdate:

* School Attending:

* School District:

* Years of Football Experience:

How did you hear about us?:

PARENT/GUARDIAN #1

* Firstname/MI:

* Lastname:

* EMail:

Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname/MI:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Insurance Carrier:

Policy #:

I/we agree with the above *

When making a payment or payments, please be sure to indicate person or persons whom you or paying for in the special instructions section to seller of paypal, thanks.

By me clicking submit, that's my signature and I certify that I am the legal parent or guardian of the above named applicant.

Signature:

Date:

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

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