[Single Question] Lions Cheerleading Registration Form & Information Sheet

1
How many cheerleaders are you registering?* This field is required
One
Two
Three
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2
Cheerleader Name* This field is required
First Name
Last Name
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3
Cheerleader Name 2* This field is required
First Name
Last Name
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4
Cheerleader Name 3* This field is required
First Name
Last Name
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5
Cheerleader DOB* This field is required
Example 01/15/2008
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6
Cheerleader 2 DOB* This field is required
Example 01/15/2008
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7
Cheerleader DOB* This field is required
Example 01/15/2008
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8
Age* This field is required
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9
Cheerleader 2 Age* This field is required
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10
Cheerleader 3 Age* This field is required
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11
Grade (Fall of 2017)* This field is required
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12
Cheerleader 2 Grade (Fall of 2017)* This field is required
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13
Cheerleader 3 Grade (Fall of 2017)* This field is required
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14
Where do they attend school?* This field is required
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15
Parent Names* This field is required
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16
Address* This field is required
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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17
Parent Cell Phone Number* This field is required
Area Code
Phone Number
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18
Cheerleader Cell Phone Number
Area Code
Phone Number
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19
Primary E-mail* This field is required
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20
Secondary E-mail* This field is required
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21
Cheerleader Name
First Name
Last Name
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22
Cheerleader Name
First Name
Last Name
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23
Cheerleader 3 Name
First Name
Last Name
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24
Age as of August 1st, 2018
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25
Cheerleader 2 Age as of August 1st, 2018* This field is required
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26
Cheerleader 3 Age as of August 1st, 2018* This field is required
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27
Cheerleader DOB* This field is required
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28
Cheerleader 2 DOB* This field is required
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29
Cheerleader 3 DOB* This field is required
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30
Grade (Fall of '18) * This field is required
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31
Cheerleader 2 Grade (Fall of '18) * This field is required
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32
Cheerleader 3 Grade (Fall of '18) * This field is required
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33
Height
Estimate if you don't know
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34
Cheerleader 2 Height
Estimate if you don't know
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35
Cheerleader 3 Height
Estimate if you don't know
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36
Weight
Estimate if you don't know
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37
Cheerleader 2 Weight
Estimate if you don't know
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38
Cheerleader 3 Weight
Estimate if you don't know
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39
Any experience on an organized cheer squad? * This field is required
Yes
No
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40
(Cheerleader 2) Any experience on an organized cheer squad? * This field is required
Yes
No
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41
(Cheerleader 3) Any experience on an organized cheer squad? * This field is required
Yes
No
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42
How many years?
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43
Cheerleader 2 - How many years?
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44
Cheerleader 3 - How many years?
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45
For whom did they cheer?
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46
Cheerleader 2 - For whom did they cheer?
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47
Cheerleader 3 - For whom did they cheer?
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48
List any allergies* This field is required
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49
Does your cheerleader need/use an inhaler?* This field is required
Yes
No
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50
Cheerleader 2 - Does your cheerleader need/use an inhaler?* This field is required
Yes
No
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51
Cheerleader 3 - Does your cheeleader need/use an inhaler?* This field is required
Yes
No
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52
Cheerleader 2 List any allergies* This field is required
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53
Cheerleader 3 List any allergies* This field is required
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54
List any past injuries that we need to be aware of* This field is required
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55
Cheerleader 2 - List any past injuries that we need to be aware of* This field is required
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56
Cheerleader 3 - List any past injuries that we need to be aware of* This field is required
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57
List two phone numbers (and contact names) we can call in case of an emergency.
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58
Emergency Contact 1 Name* This field is required
First Name
Last Name
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59
Emergency Contact 1 Phone Number* This field is required
Area Code
Phone Number
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60
Emergency Contact 2 Name (non parent)* This field is required
First Name
Last Name
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61
Emergency Contact 2 (non parent) Phone Number * This field is required
Area Code
Phone Number
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62
Name of Physician* This field is required
First Name
Last Name
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63
Physician Phone Number
Area Code
Phone Number
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64
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65
Please Select The Date* This field is required
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66
Name* This field is required
First Name
Last Name
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67
Address* This field is required
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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68
Home Phone* This field is required
Area Code
Phone Number
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69
Cell Phone* This field is required
Area Code
Phone Number
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70
Work Number* This field is required
Area Code
Phone Number
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71
Phone number in case of an emergency* This field is required
Area Code
Phone Number
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72
An email to notify you at* This field is required
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73
Please list pre-existing medical conditions, such as asthma, allergies, etc.:* This field is required
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74
Does your player need/use an inhaler? * This field is required
Yes
No
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75
Insurance Company* This field is required
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76
Insurance Carrier* This field is required
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77
Policy Number* This field is required
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78
* This field is required
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79
We have a website at lionsfootballclub.com and maintain several social media accounts. In order to promote our program, we post pictures, videos, and general text content that may include your son or daughter's image in a photo (example: making a great tackle).

We need your permission to utilize their image.
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80
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81
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82
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83
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84
* This field is required
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85
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86
Player* This field is required
First Name
Last Name
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87
Place: Marion County and various places
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88
* This field is required
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89
For Minor Child
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90
Initials* This field is required
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91
Date Signed
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92
Student Athletes Name* This field is required
First Name
Last Name
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93
* This field is required
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94
Does your daughter attend a private, public or charter school that has a cheer program at their school but are choosing not to participate on?* This field is required
Yes
No
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95
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96
Parent Initials* This field is required
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97
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98
Player Initials* This field is required
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99
* This field is required
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Should be Empty: