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Valley Cottage Indians Cheer and Football Registration
*
Childs First Name:
Middle Intial:
*
Childs Last Name:
Childs Name Suffix. ie: Jr, I, II, etc.:
Jr.
I
II
III
IV
V
*
Childs Date of Birth:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
*
Please select the program your registering your child for (Childs age as of July 31st):
Jr Tiny Mite Cheer (3-4)
Cheer (Ages 5-15)
Dance (Ages 12-15)
Tackle Football (Ages 5-14)
*
Address:
*
City/County:
*
State:
NJ
NY
*
Zip Code:
*
Home Phone Number (XXX) XXX-XXXX:
Cell Phone Number (XXX) XXX-XXXX:
*
Parent/Guardian Email Address:
*
School child will be attending in September of current year:
*
Grade of child in September of current year:
NA
K
1
2
3
4
5
6
7
8
9
10
11
12
*
Medical Information/check and/or provide applicable information:
NA
Glasses/Contacts
Diabetic
Asthmatic
Seizures
Hearing Impaired
Speech Impaired
Other
*
Allergies (please check appropiate):
None
Bee Stings
Penicillin
Other
Medications (please list as well as any other allergies not listed above):
*
Parent/Guardian First Name:
*
Parent/Guardian Last Name:
Parental Consent:
Your submission of this form will be used as your consent for the child named within to participate in activities involving Pop Warner Youth Football/Cheerleading and Valley Cottage Indians. You also give permission for the child named within to travel with their team/sqaud/association, in adherance with scheduled home/away game(s). You further agree that you shall not hold responsible any officer, coach or staff member of his/her Association or Organization (RCPWYFL) for any injury or damages sustained by the child named within while participating in such activities.
You also understand that your submission of this form indicates blanket approval and covers all team/squad related activities and, in the event of your absence, the right to approve and/or administer medical assistance as needed.
VOLUNTEER: We can always use your help. Please select what area you would like to volunteer for:
Annaul Awards Brunch
Announcer (Home Football Games)
Business Manager
Chain Crew (Football Games)
Cheer and Football Journal
Coach Cheer
Coach Football
Concession Stand
First Aide
Fund Raising
Journal Ads
Photographer (Practice and Home Games Cheer/Football)
Security
Spotter (Football Games - play counter)
Uniform Collection
Uniform Distribution
Please complete the following if you've registered your child for Cheer/Dance.
Shirt sizing for Cheer/Dance Only:
NA
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult XX-Large
Shorts sizing for Cheer/Dance only:
NA
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult XX-Large
Socks sizing for Cheer/Dance Only:
NA
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult XX-Large
Sneaker Size:
K10
K11
K12
K13
1
1.5
2
2.5
3
3.5
4
4.5
5
5.5
6
6.5
7
7.5
8
8.5
9
9.5
10
10.5
11
11.5
12
Thank you for your registration for the Valley Cottage Indians Pop Warner Cheer and Football Program.
Please make payment in the amount due to Valley Cottage Indians and forward your payment to:
Valley Cottage Indians
PO Box 79
Valley Cottage, NY 10989
Attn: Director, Cheer/Football
Thanks again and look forward to welcoming you and your child.
Due to the number of applications please be sure to complete the application process by sending in your payment promptly -
* indicates required fields