Language
English (US)
Shelby Park Jaguars Football/Cheer Sign ups
Child's Name
First Name
Last Name
Child's Birthdate
ex: XX/XX/XXXX
Child's Age
What team would your child be playing or cheering on this year?
Football
Cheerleading
Father's Name
First Name
Last Name
Mother's Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Family Doctor Provider
Doctors Name
First Name
Last Name
Doctor's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Doctor's Phone number
-
Area Code
Phone Number
Preferred Hospital
Medication child is taking
Allergies
Back
Next
Emergency Contact
Parent/Guardians Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Relationship to child
Insurance Provider #1
Insurance Carrier
First Name
Last Name
Insurance ID number
Insurance Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Insurance Phone Number
-
Area Code
Phone Number
Insurance Provider #2
Insurance Carrier
First Name
Last Name
Insurance ID number
Insurance Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Insurance Phone Number
-
Area Code
Phone Number
Back
Next
Upload Pictures or Files
Upload Birth Certificate
Browse Files
Cancel
of
Waiver and Releases of Liability- Minor Form
Browse Files
Cancel
of
Emergency Medical Treatment, Consent and Information Form
Browse Files
Cancel
of
Image Release - Minor Form
Browse Files
Cancel
of
Terms and Conditions
I understand that the name entered below will be participating in a contact sport and understand the risk or injury while under the care and control of the I will not hold TYSA or any individual responsible for any accidents that may occur while under the care and control of TYSA. Furthermore, I authorize the members of the TYSA to refer to emergency medical professionals if they feel it necessary for the child's wellbeing.
Signature
Powered by
Jotform Sign
Clear
Submit
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform