Thursday
May 28/20
4:27 am
EST

N O R T H S I D E
Seminoles
ONLINE APP
www.ballcharts.com/NSAFOOTBALL

Admin

Attendance:


Jasper
FL
USA






 

                    No Refund Policy

 

 

$35 For Football                $25 For Cheer

 2012

 

Application

 

 

Last Name :___________________ M.I.___  First Name :_____________________

 

D.O.B :____/____/______  Age :______   Grade :________

 

SSN :_____-____-______  

 

Address :________________________       __________________     ____________

                          (Street)                                             (City)                         (State)

 

_____________     Cell Phone :_________________ Home Phone :_________________ 

    (Zip Code) 

                               Work Phone :__________________

 

Parent / Guardian Name :_________________________

                                                      (Please Print)

Email Address :_________________________________

                                      (Please Print Clearly)

 

_____________________ (Child Is Participating In Following) ___________________

 

[] AYF (Football)    or    [] AYC (Cheer/Dance)

 

___________________________(In Case Of Emergency) ________________________

 

 

Contact  # 1

Name :______________________  Phone Number :_______________________

Address :_________________________________

Relationship :______________________________

 

 

 

Contact  # 2

Name :______________________  Phone Number :________________________

Address :__________________________________

Relationship :_______________________________

            

 

 

 

 

Medical History

 

 

List all medical needs & history below :_______________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

 

 

X______________________     X_____________________    Date___/___/______

       (Print Child Name)                      (Child Signature)

X______________________     X_____________________    Date___/___/______

       (Print Parents Name)                   (Parent Signature)

 





 


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