CHESTER JETS CHEER REGISTRATION

Parent/Guardian First Name:(Required)

Parent/Guardian Last Name:(Required)

Parent/Guardian Cell Phone:(Required)

Email:(Required)

Parent/Guardian 2 First Name:

Parent/Guardian 2 Last Name:

Parent/Guardian 2 Cell Phone:

Parent/Guardian 2 Email:

Player Information

First Name:(Required)

Middle Name:

Last Name:(Required)

Child Date of Birth(Required)

DIVISION(Required)

School:(Required)

Grade:(Required)

Address:(Required)

Address 2:

City:(Required)

State:(Required)

Zip / Postal:(Required)

Upload Player Headshot(Required)

Drop files here or

Max. file size: 1 GB.

Upload Government Issued ID(Required)

Drop files here or

Max. file size: 1 GB.

Emergency Contact

Primary Emergency Contact Name:(Required)

Primary Emergency Contact Phone Number:(Required)

Primary Emergency Contact Relationship to Player:(Required)

Secondary Emergency Contact Name:

Secondary Emergency Contact Phone Number:

Medical History

UPLOAD PROOF OF PHYSICAL(Required)

Max. file size: 1 GB.

Does the player have any allergies that we need to be aware of? *(Required)

Does the player have any other medical conditions that we need to be aware of? *(Required)

If you answered yes please explain:

IMAG RELEASE(Required)

YES , I GIVE PERMISSION

I give permission for any image of the Participant to appear in pictures, photographs, electronic images, video, audio, any publications, on any website or other electronic media and for VIRGINIA UNITED / VIRGINIA SPORTS to share such images with third parties without payment or renumeration to either the Participant or the Parent or Legal Guardian.

REGISTRATION(Required)

Price:

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