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)

Month

Day

Year

DIVISION(Required)School:(Required) Grade:(Required)

Address:(Required)

Street Address

Address 2:

Street Address

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:

Payment Method*

MasterCardVisaSupported Credit Cards: MasterCard, Visa
Card Number
Expiration Date

Security Code

Cardholder Name