Elite Sirius Little Dipper Package
Athlete Information
Name
*
First Name
Last Name
Age
*
Grade Level
*
Height
*
Weight
*
Primary Position
*
Please Select
Quarterback
Running Back
Wide Reciever
Tight End
Offensive Tackle
Offensive Guard
Center
Defensive Tackle
Defensive End
Inside Linebacker
Outside Linebacker
Cornerback
Safety
Kicker
Punter
Secondary Position
*
Please Select
Quarterback
Running Back
Wide Reciever
Tight End
Offensive Tackle
Offensive Guard
Center
Defensive Tackle
Defensive End
Inside Linebacker
Outside Linebacker
Cornerback
Safety
Kicker
Punter
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Social Media Handles
Shirt Size (Adult Size)
*
Parent/Guardian Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Information
Name
*
First Name
Last Name
Relationship to Athlete
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Information
Do you have any medical conditions we should be aware of? (If yes, please describe)
Do you have any allergies? (If yes, please describe)
Are you currently taking any medications? (If yes, please list)
Additional Information
Not required, but please provide any information you have available
40 time
Vertical Jump
225 Bench Reps
Max Bench Press
Max Squat
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Little Dipper
Little Dipper Package
$10.00
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10.00
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