Junior Rebels Order Form 2017
Please fill out all aspects of this form to ensure that the correct items and sizes are ordered for your Junior Rebel.
Multiple children participating? Please fill out separate forms for each participant! DO NOT combine order forms.
Questions? Email Levetzow@olemiss.edu

Uniform orders: For those ordering uniforms, please note that all uniform payments are due to the spirit squad office no later than Sept. 30th. All payments must be on time or your participant will not receive a uniform due to late payments.

Tickets: Participants will receive ONE ticket for the game. Parents, family, friends will need to purchase tickets at an additional cost ($25/ticket). Please indicate the number of tickets you are purchasing at the end of this document. Payment for tickets are due Sept. 30th.

Email address *
Parent Cell Phone Number (area code first) *
Your answer
Junior Rebels First/Last Name *
Your answer
Junior Rebels Age/Grade *
Your answer
Junior Rebels Height (Feet and Inches) *
Your answer
Medications (Please list any and all medication your Junior Rebel is currently taking). IF NONE, please type NONE! *
Your answer
Allergies (Please indicate any and all allergies your Junior Rebel has). IF NONE, please type NONE! *
Your answer
Previous/Existing Injuries/Medical Conditions. IF NONE, please type NONE! *
Your answer
Junior Rebel T-shirt Size (short sleeve, navy blue shirt) All Junior Rebels will receive a t-shirt. *
Poms- All Junior Rebels will receive a set of NAVY BLUE poms! Please check "yes" below *
Hair Bow- All Junior Rebels will receive a NAVY BLUE hair bow. Please check "YES" below *
Are you purchasing a uniform this year? (please note: uniforms are an additional cost of $80.00 and include a top, skirt, and bloomers) *
Uniform Top-- please indicate size. *
Uniform Skirt-- please indicate size *
Uniform Bloomers (for under your skirt)-- please indicate size *
Additional Ticket Orders $25/piece (ONE participant ticket is already provided for your Junior Rebel) Please indicate how many ADDITIONAL TICKETS YOU ARE PURCHASING. Payment for tickets are due Sept. 30th. *
Your answer
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