Eureka Junior League Football and Cheer

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Eureka Junior League Football and Cheerleader Registration 2024

PLAYER INFORMATION

* First Name:

* Last Name:

* Birthdate:

* Gender:

* How old will your child be on August 31, 2024?:

* What Elementary School will your child be attending for the 2024-2025 school year?:

* Grade?:

* What Division?:

* Zip Code:

* State:

* City:

* Street Address:

* Home Phone:

Email:

PARENT/GUARDIAN #1

* Lastname:

* Firstname:

* Street Address:

* City:

* Zip Code:

* Home Phone:

* Cell Phone:

Work Phone:

* EMail:

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 #:

All monetary transactions are final and there are NO REFUNDS.

I/we agree with the above *

* indicates required fields

Registration($300)

Sibling Registration($280)

Cheerleader Uniform($100)

Eureka Junior League Football and Cheerleader Registration 2024

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