Charlotte Lions Jr Pro Football & Cheerleading

Subscribe to our Newsletter

Charlotte Jr Pro Football & Cheerleading Registration 2018

* Child's name:

* Home phone:

* Date of Birth:

* Age:

* Gender/Sport:

* Address:

* Mother's Name:

* Mother's Cell Phone:

* Father's Name:

* Father's Cell Phone:

Guardian Name:

Guardian Cell Phone:

* Is your child currently in an alternative school program:

* Was your child enrolled in another Tri County Jr Pro Program last year:

* If so, please list the organization:

* Family Physician Name:

Physician Phone:

* Physician Address:

* Allergies:

Blood Type:

Last Tetanus:

* Any Known Health Problems:

Medical Insurance Company:

Member ID:

MEDICAL RELEASE : IN CASE OF AN EMERGENCY, IF MY FAMILY PHYSICIAN CANNOT BE REACHED I HEREBY AUTHORIZE THE ABOVE NAMED CHILD TO BE TREATED BY ANOTHER QUALIFIED LICENSED PHYSICIAN WHO IS AVAILABLE

MEDICAL RELEASE AGREEMENT *

WAIVER OF LIABILITY: I HEREBY RELEASE TRI COUNTY JR PRO FOOTBALL AND CHEERLEADING OFFICERS AND CHARLOTTE LIONS DIRECTORS AND COACHES FROM ANY LIABILITY RELATING TO THE PARTICIPATION OF THE ABOVE NAMED CHILD DURING PRACTICES GAMES OR ANY OTHER FUNCTION OF CHARLOTTE LIONS JR PRO

WAIVER OF LIABILTY AGREEMENT *

I UNDERSTAND THAT THE INSURANCE CARRIED BY THE LEAGUE IS A SECONDARY INSURANCE POLICY AND A DEDUCTIBLE MUST BE MET AFTER I HAVE FILED WITH MY OWN INSURANCE COMPANY

INSURANCE AGGREEMENT *

* Authorized Online Signature:

Signature:

Date:

* indicates required fields

OUR SERVICES

LOCAL SPORTS

ELITE

Charlotte Jr Pro Football & Cheerleading Registration 2018