Youth Tackle Football & Cheerleading
Wesley Chapel Bulls
PO Box 7557
Wesley Chapel, FL 33545-0110
http://www.wesleychapelbulls.com
Participant Information
Sport
Football
Cheerleading
First Name
Last Name
Middle Name
Sex
M
F
Birthday (MM-DD-YYYY)
Division
Jr. Flyweight *(6-7yrs)
Flyweight (8-9yrs)
Mighty Mite CHEER ONLY (10-11yrs)
Jr. Varsity (12-13yrs)
Varsity (14-15yrs)
Experience Level (Tackle Football & Cheerleading)
Never Played/Cheered Before
Played/Cheered One Season
Played/Cheered More than one Season
Sport
Football
Cheerleading
First Name
Last Name
Middle Name
Sex
M
F
Birthday (MM-DD-YYYY)
Division
Jr. Flyweight *(6-7yrs)
Flyweight (8-9yrs)
Mitey Mite CHEER ONLY(10-11yrs)
Jr. Varsity (12-13yrs)
Varsity (14-15yrs)
Experience Level (Tackle Football & Cheerleading)
Never Played/Cheered Before
Played/Cheered One Season
Played/Cheered More than one Season
Sport
Football
Cheerleading
First Name
Last Name
Middle Name
Sex
M
F
Birthday (MM-DD-YYYY)
Division
Jr. Flyweight *(6-7yrs)
Flyweight (8-9yrs)
Mighty Mites CHEER ONLY (10-11yrs)
Jr. Varsity (12-13yrs)
Varsity (14-15yrs)
Experience Level (Tackle Football & Cheerleading)
Never Played/Cheered Before
Played/Cheered One Season
Played/Cheered More than one Season
School Participant Attends
Registration Payment
If you are paying in full, indicate the total number of participants. If you are paying a deposit then only indicate "1" by the single player or multiple player selection.
Football Full Payment ($235.00)
Cheerleading Full Payment ($235.00)
Football/Cheer Single player Deposit ($100.00)
Football/Cheer Multiple player Deposit ($150.00)
NOTE: Deposit is due at the time of registration.
Household / Adult Primary Contact
Relationship to Participants:
Mother
Father
Guardian
First Name
Last Name
Address 1
Address 2
City
State
Zip
Is this the address on Participant's school records?
Yes
No
Home Phone
Cell Phone
School Participant attends.
Email Address
Confirm E-mail address
OUR PROGRAM RELIES HEAVILY ON THE ABILITY TO COMMUNICATE VIA EMAIL and
www.wesleychapelbulls.com PLEASE PROVIDE A VALID EMAIL ADDRESS & CHECK
OFTEN FOR CURRENT INFORMATION.
Emergency Contact
Name
Home Phone
Cell Phone
Name
Home Phone
Cell Phone
Insurance Information
Insurance Company
Policy Number
Group Number
Insured Name
Insurance Telephone Number
Note:
If there is no insurance indicate "None" in each of the required fields.
Medications Prescribed,if any (If multiple players, indicate player's name first)
Allergies, if any (If multiple players, indicate player's name first)
Indicates Response Required