JR/SR Cheerleading Registration

RM_Stats
Player Info
Parent Info
Refunds
Email^*
Cheerleader Information

Child First Name^*
Child Middle Name
Child Last Name^*
Gender^*
Male

Female

Date of Birth^*

Grade (in August)^*
Name of School^*

Medical Information

Medical Concerns
Allergies
Physician Name^*
Physician's Phone Number^*
Hospital of Choice^*
Medical Insurance Company^*
Medical Insurance Policy Number^*
Medical Insurance Policy Holder^*
Parent/Guardian 1 Information

Parent First Name
Parent Last Name^*
Parent Email^*
Parent Mobile Number^*
Parent/Guardian 2 Information

Parent 2 First Name
Parent 2 Last Name
Parent 2 Mobile Number
Emergency Contact

Emergency Contact Name^*
Emergency Contact Number^*
Volunteer to Coach?
Yes

No

Refunds^*
I understand that NO REFUNDS will be given unless the program does not have enough participants.
I Agree

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