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School:
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Participants Name:
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Zip Code:
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City:
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Home Address:
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Birth Date:
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Age on August 1st:
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Grade for 08/09 School Year:
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Division:
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Football or Cheer:
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Returning?:
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Father's/Guardian's Name:
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E-mail:
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Fathers Home#:
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Fathers Cell#:
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Fathers Work#:
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Mothers/Guardian's Name:
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E-mail:
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Mothers Work#:
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Mothers Cell#:
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Mothers Home#:
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Emergency Contact:
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Emergency Contact Phone #:
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Health Insurance:
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Policy #:
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Physician Phone #:
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Physician Name:
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Allergic to Medications:
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List Medication Allergies:
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Allergic to Bee Stings:
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List any serious illness, surgery, or unjury:
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List medications routinely taken:
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I understand that there are risks of physical injury associated with, arising out of and inherent to the activity of
football/cheerleading. In recognition of this acknowledged risk of injury, I knowingly and voluntarily waive all rights and/or
causes of action of any kind, including any and all claims of negligence arising as a result of such activity from which liability
could accrue to Center/Antelope Jr. Cougars, its officers, agents, employees, instructors, subsidiaries, parent corporations,
and all affiliated entities (hereinafter collectively referred to as "CAJC").
I hereby agree to release CAJC and hold CAJC harmless of all liability, and hereby acknowledge that I knowingly and
voluntarily assume full responsibility for all risks of physical injury arising out of active participation in football/cheerleading on
behalf of the participant.
I am aware that this is a release of liability and an acknowledgement of my voluntary and knowing assumption of the risk of
injury. I have signed this document voluntarily and of my own free will in exchange for the privilege of participation.
If I am a minor, my parent and/or guardian has signed this document releasing CAJC from any and all such liability described
above and has acknowledged that I am knowingly and voluntarily assuming all risks of injury inherent to this activity.
The above named student has my permission to participate in all CAJC events. I warrant the above information is complete
and correct. I hereby authorize the event directors or their agent to act on my behalf to provide emergency medical treatments.
I further release CAJC of all liabilities associated with my child attending any CAJC events. I also give CAJC permission to
use photos &/or video of my child in or on any form of advertisement.
I understand that ANY FEES PAID are non-refundable and does not guarantee my child a position on any Center/Antelope Jr.
Cougar Cheer Squad or Football Team. All equipment remains the property of CAJC. I understand that by signing this form I
assume responsibility for replacement cost in the event of failure to return equipment. I understand that try-outs will be held
for both Cheerleading and Football and my son/daughter's participation is subject to those try-outs. I also understand that
previous participation in the CAJC program does not guarantee my child a position with the association in the current
calendar year.
I am aware that it is mandatory for my child to participate in fundraising throughout the 2008 season.
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2008 REGISTRATION FORM
*Football Program Cost: $225
non-refundable deposit due at registration of $50, balance due by August 1, 2008
*Cheer Program Cost: $300
non-refundable deposit due at registration of $100, balance due by uniform fitting in June
(date to be announced)
All parents/guardians are required to work 10 hours per child in the league. There is a refundable $100 deposit for
equipment return & parent participation hours due at registration. This deposit will be refunded upon completion of your
10 hours.
All participants must have a physical exam completed
AFTER April 1, 2008 and BEFORE July 31, 2008
New players and cheerleaders MUST provide an original birth certificate AT THE TIME OF REGISTRATION.
Returning players and cheerleaders do not need birth certificates.
**REGISTRATIONS WILL BE HELD AT MOUNTAIN MIKE'S PIZZA**
(4207 Elverta Road in the Winco shopping center)
FOR DATES AND TIMES CHECK OUR WEBSITE AT www.antelopejrcougars.com
MAIL COMPLETED REGISTRATIONS TO:
CENTER/ANTELOPE JR. COUGARS
PMB# 188
4117 Elverta Road, Suite 102
Antelope, CA 95843
Regular season practices begin in August.
Games are played on Saturdays, September-November.
Practices and home games will be held at Center High School.
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I have read & acknowledged the above listed information regarding the 2008 Center Jr. Cougar program.
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