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Youth Cheer and Song Clinic
Registration
Payment
Review
Registration
Parent Information
Required
First Name
*
Required
Last Name
*
Required
Please enter a valid email address with the format youraddress@yourdomain.
Email
*
Required
Please enter a 10-digit phone number. You can use hyphens or periods to separate numerals, and you can put the area code in parenthesis.
Phone Number
*
Required
Home Address
*
Required
City
*
Required
State
*
Required
Please enter a 5-digit ZIP code or a 9-digit ZIP code with a hyphen after the first 5 digits.
Zip Code
*
Participant Information
Required
Participant's Full Name
*
Required
Date of Birth
*
Required
Fall 2023 Grade
*
Required
Fall 2023 School
*
Required
Insurance Carrier
*
Required
Insurance Policy Number
*
Emergency Contact Information
Required
Emergency Contact Name
*
Required
Phone Number
*
Required
Relationship to Camp Attendee
*
Signatures
Required
Primary Guardian's Electronic Signature
*
Required
Participant's Electronic Signature
*