Yreka Chargers Youth Football & Cheerleading Association

PO BOX 812, YREKA CA 96097
'09 Registration Form

Division you wish your Athlete to participate in. Cheerleaders are divided by age only:

Mighty Mite (age 6-7- weight 45-85#)         * If 6 or 7 by 11/1/09, you must be MM*
Jr. Pee wee (age 8-9- weight 50-95#)            Pee Wee (age 10-11- weight 60-115#)
Jr. Midget (age 11-13*- weight 70-145#)       Midget (age 12-14*- weight 110-190#)
Sport you wish your Athlete to participate in:       CheerLeader          Football Player
Athlete’s Name:
Athlete’s Physical Address: , , ,
Athlete’s Date of Birth:          Age (on Nov. 1, 2010):
Home Phone:                - -          Cell Phone:                   - -
Parent's Work Phone:    - -          Emergency Phone:         - -
Name of Primary Insured:   Insurance Provider:
Policy Number:
Father /Guardian Name:        Mother /Guardian Name:   
Mailing Address: , , ,

**E-Mail:      **Please provide email. Important for easy communication.

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