2022 CCL/EYSA Registration Form
Please complete all sections of this form to register your child for cheer. Basketball cheer registration is $200.00. Ages for basketball cheer are 5-18. This form is required for all participants. Your physical signature will be required before your child is allowed to participate. If you complete this information online, a printed pre-filled copy of your registration will be provided to you by the EYSA Cheer Director. Please visit www.eysacheerleading.org for additional information.
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Email *
2021 Cheer Season Parents - Please select one of the choices below if your child cheered the 2021 cheer season and DID NOT receive her warmups and sleeves.
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MEDICAL FORM
COMPLETION OF THIS FORM WILL COVER YOUR CHILD AT ALL CCL EVENTS FOR THE CURRENT YEAR
Child's First Name *
Child's Middle Name *
Child's Last Name *
Parent 1 -  Full Name *
Parent 1 - Are you interested in becoming a team parent? Team Moms/Dads automatically serve on the Director's Advisory Board. Please see a detailed description of the Director's Advisory Board and additional committees below: *
Parent 1 - Please check committees in which you would like to serve. Please note that committee chairs are also members of the Director's Advisory Board. *
Required
Parent 2-  Full Name *
Parent 2 - Are you interested in becoming a team parent? Team Moms/Dads automatically serve on the Director's Advisory Board. Please see a detailed description of the Director's Advisory Board and additional committees below: *
Parent 2 - Please check committees in which you would like to serve. Please note that committee chairs are also members of the Director's Advisory Board. *
Required
Child's Birth Date *
MM
/
DD
/
YYYY
Elementary School Boundary *
Grade for 2022 Season *
Size Information
Please select your child's uniform size from the sizing charts below. 
Measuring Your Child
Uniform Sizing Chart
Top
Skirt
Briefs
Warm Up Sizing Chart
Warm Up Top
Warm Up Pants
Shoe Size (Please specify whether sizes are Preschool (10.5-3.0), Grade School (3.5-7.0), or Women's. *
Shirt Size *
Contact Information
Street *
City *
State *
Zip *
Telephone Number *
EMERGENCY CONTACT INFORMATION
In the case of an emergency, please identify someone to call regarding your child.
Emergency Contact 1 -Name *
Emergency Contact 1 -Relationship *
Emergency Contact 1 - (Home) Telephone Number *
Emergency Contact 1 - (Business) Telephone Number *
EMERGENCY CONTACT 2
Emergency Contact 2 -Name *
Emergency Contact 2 -Relationship *
Emergency Contact 2 - (Home) Phone Number *
Emergency Contact 2 - (Business) Phone Number *
THIS FORM DOES NOT REQUIRE A PHYSICAL EXAMINATION
Please list ALL allergies: (If none, please list N/A.) *
Please list allergies to medication: (If none, please list N/A.) *
Please list medication which participant is currently taking: (If none, please list N/A.) *
Please make any necessary comments concerning physical condition, restrictions of participant, if any, etc: (If none, please list N/A.) *
INSURANCE INFORMATION: Please list name and address of insurance company that covers participant.
Please check if participant is NOT covered by an insurance policy. Please be aware that bills will be sent directly to parent or legal guardian.
Name of Insurance Company (If none, list N/A.) *
Policy Number (If none, list N/A.) *
Insurance Company Mailing Address (If none, list N/A.) *
Insurance Company City (If none, list N/A.) *
Insurance Company State (If none, list N/A.) *
Insurance Company Zip (If none, list N/A.) *
Name of Subscriber (If none, list N/A.) *
Relationship to Participant (If you answered N/A to the question above, please list N/A below.) *
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