Jr. Longhorn 2011
Player's name
Birthday (mm/dd/yyyy)
Grade for 2011-12
Address (Street/Town/Zip)
Parent1
Parent2 (if applicable)
Today's date (mm/dd/yyyy)
Home Phone
Alt. Phone(s)
email addresses
Height (ft & in)
weight (lbs)
Preferred Jersey #
Prior Experience (Y/N)? Yrs?
Current School
Intended High school
Sponsor a player afterschool?
Yes
No
I agree to the above
Yes, I agree
No
Program Guideline Acknowledgement
Yes, I have read and agree.
No
Helmet Warning Acknowledgement
Yes, I have read the Helmet Warning
No
SAC Camp Registration
Yes
No
Emergency Contact
Preferred Emergency Phone #
Physician's Name
Physician's phone #
Dentist Name
Dentist Phone #
Insurance Provider
Insurance Policy #
Medical Alert Answer
Any allergies?
Preferred Hospital?
Other information to be aware of?
