Kiwanis Kid Day Cheer 2023 Registration
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Last Name *
First Name *
What grade is your child entering this Fall *
Date of Birth *
MM
/
DD
/
YYYY
Home Street Address *
City *
Zip Code *
Primary Contact Last Name - THIS PERSON WILL ALSO BE CONSIDERED EMERGENCY CONTACT #1 *
Preferably a parent within the home; this person will be responsible for ensuring the player is informed of practices, game, and other pertinent information.
Primary Contact First Name *
Primary Contact Phone Number *
(479)123-4567
Primary Contact Relationship *
Primary Contact Email *
Secondary Contact Last Name THIS PERSON WILL ALSO BE CONSIDERED EMERGENCY CONTACT #2.           *
Preferably a parent within the home; this person will be responsible for ensuring the player is informed of practices, game, and other pertinent information.
Secondary Contact First Name *
Secondary Contact Phone Number *
ex: (479) 123-4567
Secondary Contact Relationship *
Secondary Contact Email *
Do you have a SIBLING playing football? *
if so, please list their name, age, and grade below
I, AS THE Parent or Guardian of the child for whom this form has been submitted, do hereby state that all the information above is true and correct. It is further understood that all participants must compete in the grade level they are going into. Any falsification or misrepresentations will result in the disqualification of the participant. All final decisions rest with the Springdale Kiwanis Club. I am agreeing to allow my child to participate in kid’s Day Football, I hereby release the Springdale Kiwanis Club, Springdale School District, Springdale Athletic Department, and the Springdale Youth Center, as well as the representatives of said organizations, of any and all responsibility from accident, injury or sickness. *
Please initial indicating your agreement to the above paragraph
T-shirt size?
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