Mount Vernon ISD Tryout Packet
Email *
Cheerleader First Name  *
Cheerleader Last Name  *
Shirt size *
Age *
Birthday *
MM
/
DD
/
YYYY
Gender *
Parent Contact name: *
Contact Phone (parent/guardian)  *
Email (parent/guardian)  *
Home Address *
City *
Zip Code *
Allergies *
Is student taking medication routinely? *
If yes, what type and how often?  
Family Physician *
Family Physician Phone *
Hospitalization Insurance Company (If none please write this below) This information will only be used if your child is in need of emergency help or is transported by ambulance. Many times we travel out of town and in the case that a coach needs to take a cheerleader to the hospital, we will need this info . *
Policy Number *
Hospital Preference *
Name of Parent or Guardian we should contact FIRST in the case of emergency *
Parent or Guardians phone number *
Second emergency contact name *
Second emergency contact phone *
Do you consent in emergency cases, for a coach or school employee to drive your child in a school or their personal vehicle to receive treatment? *
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