Online Registration Form/Payment

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: ____________________

* required


Choose From Drop Down Box or Check Box Below

Spot Holder Payment($55)
Partial Payment($105)
Partial Payment($130)
Partial Payment($155)
Partial Payment($180)
Partial Payment($205)
Total Payment-Football($230)
Total Payment-Cheer($255)

Payments Accepted By

Note: Credit Card information can be entered once this form is submitted