Participant Information

Today's Date

Participant Name *

Please enter the first name of the participant

Please enter the last name of the participant


Participant Age *

Please enter the date of birth

Participants must be 5 years old and up.

Please enter a valid number for age.


Participant School *

Please enter the participant's school

Please select participant's grade


Gender *

Please select the participant's gender


Sport *
Football and Cheerleading include the refundable $50 uniform deposit. Community Center Admission is $25.00 for those 18 years or older.

Please enter the sport the participant is registering for


Contact Information

Contact Information *

Please enter a valid email address.

Please enter a valid phone number.


Address Information

Please enter the address of the participant

Please enter the city of the participant

Please select the state of the participant

Please enter the zip code of the participant



Parent/Legal Guardian Information

Mother/Guardian First & Last Name *

Please enter the first name of the Mother/Guardian for the participant

Please enter the last name of the Mother/Guardian for the participant


Father/Guardian First & Last Name *

Please enter the first name of the Father/Guardian for the participant

Please enter the last name of the Father/Guardian for the participant


Emergency Contact *

Please enter the emergency contact's full name

Please enter a valid phone number in the following format: XXX-XXX-XXXX


Insurance Information *

Please enter the insurance carrier

Please enter the policy number


Questions and Medical Information

Questions

PLEASE LIST ANY MEDICAL CONDITION AND/OR MEDICATIONS NEEDED

Review and Submit

Today's Date

Participant First Name

Participant Last Name

Participant Birthday

Participant Age

School

Grade

Gender

Sport

Email

Mobile

Street Address

Street 2

Town

State

Zipcode

Mother/Legal Guardian First Name

Mother/Legal Guardian Last Name

Father/Legal Guardian First Name

Father/Legal Guardian Last Name

Emergency Contact Name

Emergency Contact Phone

Insurance Carrier

Policy Number

General Questions

Medical Needs

Consent and Release Form *

Please enter your full name here to acknowledge the above





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Payment Information

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Recreation Information

See Recreation Fees here: Fees