Force Cheerleading Checklist Player Name: _______________________________________________________ In order to participate, please provide the following: Included in this document: 1. 2. 3. 4. 5. 6. 7. 8. Read Force Cheerleading Guidelines (4 Pages) – Pgs. 2-5 Signed Cheerleading Guidelines form – Page 5 Completed Registration Form (5 Pages) – Pgs. 6-10 Signed Football League Cheerleader’s Code of Conduct (1 Page) – Pg. 11 Signed Football League Parent’s Code of Conduct (1 Page) – Pg. 12 Signed Amateur Athletic Waiver and Release of Liability (1 Page) – Pg. 13 Signed Parent Approval Form – Medical Release Form (1 Page) – Pg. 14 Signed Photo Release Form (1 Page) – Pg. 15 Items you must provide: 1. Current Sports Physical – signed by a doctor (valid for 1 year from physical date and must not expire during the season) http://forcehsfootball.com/wp-content/uploads/2014/02/physicalform2014.pdf 2. Fall “current year” Declaration of Intent or letter from private school http://www.gadoe.org/Curriculum-Instruction-and-Assessment/Pages/Home-Schools.aspx 3. Copy of Child’s Birth Certificate As part of league requirements we will be taking photos of parents and children. Thanks! 1|P a g e Force Cheerleading Guidelines We are looking forward to a great 2015 season! Please read this packet carefully as it contains information for the entire season. Registration FAQs: Who is eligible? Girls 12 years old through 12th grade Are there tryouts? No! All girls, regardless of skill level, are encouraged to participate! What is the time commitment? 1. Spring practice begins in mid-April and continues through mid-May. Practices are from 6:00-8:15pm at Gary Pirkle Park. Exact dates to be announced. 2. Uniform fitting – Tuesday, April 28 at Sugar Hill Community Center from 6-8. A parent is required to accompany the cheerleader to approve uniform fit. No uniforms are ordered without parental approval. 3. Cheer camp – Monday, 6/22 through Wednesday, 6/24. We spend each day at Cheer Factory learning the halftime routine! Evenings at the hotel are spent in additional practice, teambuilding exercises, and fellowship. Girls who do not attend camp are not guaranteed a position in the half-time routine. 4. Regular season – Practices will be each Monday, Tuesday, and Thursday, and Friday nights from 6:00-8:15 in late July. Each girl needs to be committed to attending ALL practices so the squad is ready for game night! Games will begin in August. Our half-time routine is designed to include every girl, so attendance at the Friday night games is absolutely crucial. Please plan to be in town for the 10(or so) regular season games from mid-August through the end of October! Please prayerfully consider the commitment this program requires to decide if it is a good fit for your daughter and family. We need each girl to be committed to the squad. We work together as a team and depend on each cheerleader; each girl is important to THE SQUAD! 5. What are the fees? Fee Schedule: After the $100 initial fee, the balance is due in full by April 26. Uniforms will not be ordered until fees are paid in full. Approximate Fees for New Varsity Cheerleader: Approximate Fees for Returning Varsity Cheerleader Fee Includes: Game uniform, long sleeve shirt & bloomers (new girls only) Shoes Hair bow Practice uniforms Camp Megaphone and poms Force warm up suit $ 925 $ 650 What is not included: Black spandex to be worn under practice shorts White no-show socks Parents and cheerleaders: Please read the following information and complete the form on page 6. 2|P a g e Force Cheerleading Guidelines Practices: Once you have registered, you have made a commitment to the squad. Please attend and be on time for practices. If you are not at practice, the rest of the squad suffers. If you cannot attend a practice, please call the Head Coach in advance! Angie’s number – 404-423-8014 Parents - Please do not withhold your child from practice or a game as punishment because this punishes all of the girls. We can work with you, if needed. Parents – Please discuss any medical conditions, doctors’ orders, or physical limitation requests directly with the Cheer AD and/or Head Coach either by phone, in person, or by note/email rather than through the cheerleader. Parents will contact the Head Cheer Coach in the event that the cheerleader is sick or unable to practice. In the event of an inability to practice due to an injury, a doctors’ note is required, and the doctors release in order to return to practice. Parents - please be on time to pick up your child after each practice. Coaches are not responsible for your child before or after practice. Cheerleaders should be in uniform and ready to begin promptly at 6:00. Please eat snacks, use the restroom, and pull hair back before practice begins. We only have two hours for practice and we’ll need every minute! Girls who are not ready for practice in any way – late, incorrect uniform, wearing nail polish, wearing jewelry, etc. - will have consequences. There will be no eating on the field. If injured, the cheerleader will attend all practices and games, in full uniform, and support the squad on the sideline (not in the stands with friends). There are occasions when girls must miss a game due to a family emergency or illness. During practice, the coaches will make every effort to adapt the half-time routine so the squad can still perform it during the game. It is possible that girls who miss practice when these changes are made may not be able to perform during half-time. This is another reason that it is so important to be at every practice; be there for your team! Games: What you have been working for – Every Friday night is game night!! Game information will be posted on our website http://www.forcehsfootball.com along with directions to each game. While it’s a long drive, we can enjoy fellowship time with the Force Family either on buses or by carpooling. We arrive 1 ½ hours before each game. We warm up, practice stunts, and prepare for the kick-off. For your child’s safety, please don’t be late! Arrive in full uniform to each game, even if injured. We will be ready to GO! Practice! Each cheerleader must know the cheers & dances, or may be asked to sit out during a game. It is your responsibility to know cheers, dances, and the half-time routine. Once you arrive at the field, the Head Cheer Coach must know where you are at all times. Please do not leave the squad without a coach’s permission. Even if injured, the cheerleader will attend all practices and games in full uniform and support the squad on the side-line (not in the stands with friends). 3|P a g e Force Cheerleading Guidelines Attire: Uniforms: Fitting for shoes, uniforms and practice uniforms will be held on April 28. Because uniforms are custom-made, there are not returns. Any alterations must be pre-approved by the coach and paid for by the family. We will have assigned practice and game day uniforms. Cheerleaders must be in complete uniform at each event, even if injured. Because we perform stunts, many of these rules are for safety purposes. Appropriate undergarments are required. Spandex shorts must be worn under practice shorts. Sports bra straps should never be seen, so please make sure your black game day sports bra is the racerback style. Cheerleaders may not change into inappropriate attire after practice at the field. No jewelry, gum, nail polish, visible tattoos, body piercing, or unnatural hair color. A parent must be present at the uniform fitting! No uniforms will be ordered without the parent’s approval of the fit. Camp: We will have a mandatory camp in June. The cost is included in the registration fee. During our 3-day camp we learn the half-time routine at a cheer gym. Camp enables us to perform the half-time show with stunts. If you cannot attend camp, we cannot guarantee your position in the half-time routine or the stunts. Camp is so much fun!! After spending the day at the gym, we have time for team building activities, sharing meals, and getting to know each other. We’ll also review the routine, have time to share in devotions, and enjoy some laughs. Nights are spent at a local hotel, with a coach/chaperone in each room. This is a very supervised experience! Devotions: We will have a brief time of devotion during each practice based on scripture. Players are encouraged to participate. With our peers, we work to build and strengthen our character through Christ. Restrictions: Due to Insurance requirements, parents, siblings, friends and non-participants are not allowed on the field during any practice or game. Behavior: No excessive talking or laughing. This is especially dangerous during stunting. Coaching is the responsibility of the coaches, not the cheerleaders. Unless directed by the coaches, girls will not attempt to explain stunting techniques. Disrespectful words and attitudes hurt everyone! Let’s encourage one another through affirmation, encouragement, and prayer! Disrespectful behavior, including gossiping, will have consequences. Each girl is responsible for learning all of the cheers and dances. If a player doesn’t know the cheer or dance, she will be asked to sit out. No cell phones are to be used during practice or a game without the permission of a coach. As a member of the Force organization, all parents and players agree to present themselves in a manner honoring Christ. Please know that all parents and players are watched by outsiders as a Christian example. Please honor Christ on the field, off the field, and all social media, including Facebook and Twitter. 4|P a g e Force Cheerleading Guidelines Captain / Co-Captains: IF we elect to have a Captain and Co-Captain, these positions will be chosen at the coaches’ discretion, not popularity, and based on: Christ-like character Positive attitude and maturity Leadership Force experience Volunteer Positions: In order to reduce our field fees, we have partnered with the City of Sugar Hill. All Force players and parents are required to work at a Sugar Hill event. Times and dates will be announced in official Force emails. We are required to help Sugar Hill AND it’s fun! Additionally, please sign up to get involved with the Force Family. It takes all parents working together to run our VOLUNTEER program. It’s a great way to get to know the other families. If you cannot give of your time, your Registration Fee will be increased by $100. The Georgia Force organization can only be as fantastic as the Force Family volunteers make it! If we each commit to working for the good of others, we will have a program that serves our children and families well. We are looking forward to a great year of cheering while ministering to your daughter. Your encouragement and prayers for our team and leaders are always appreciated. In Christ, Sheri Spivey – Force Cheer Athletic Director Angie King – Varsity Head Coach Please call or text any required communication to Coach Angie (404) 423-8014 I have read and agree to follow all of the Cheerleading Guidelines. I understand that the Force will follow Matthew 18:1517 (NIV) concerning disciplinary actions. 15 “If your brother or sister sins, go and point out their fault, just between the two of you. If they listen to you, you have won them over.16But if they will not listen, take one or two others along, so that ‘every matter may be established by the testimony of two or three witnesses.17If they still refuse to listen, tell it to the church; and if they refuse to listen even to the church, treat them as you would a pagan or a tax collector. Player’s Signature: ______________________________________________ Date: __________________ Print Name: _____________________________________________ Parent’s Signature: ______________________________________________ Date: __________________ Print Name: _____________________________________________ 5|P a g e Force Cheerleading Registration Form Name of Participant: __________________________________________ Date of Birth: ______________ Parent’s Name(s): ______________________________________________________________________ Address: _____________________________________________________________________________ _____________________________________________________________________________________ Home Phone: _______________________________ Work Phone: ____________________________ Dad’s Cell: __________________________________ Player Cell: _____________________________ Mom’s Cell: _________________________________ Alternate Number: _______________________ Please circle ONE phone number above to be put on the Calling Post as an emergency number to get out last minute information to a family. Parent’s e-mail: ________________________________________________________________________ Player’s e-mail: ________________________________________________________________________ Cheerleader Information Weight: ______ Height: _____ T-Shirt size: YM YL AS AM AL AXL AXXL Participation in other sports: _____________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Please list any sports/events which may affect participation during the upcoming season. Dates/times: __________________________________________________________________________ Dates/times: __________________________________________________________________________ Dates/times: __________________________________________________________________________ Please Note: All Fees are non-refundable 6|P a g e Force Cheerleading Registration Form Eligibility – In order to participate in the League, participants must meet the following requirements: 1) Participant must not turn 19 years of age prior to May 1st. 2) Participant must be home schooled or be attending a private or Christian school, which has no football program. 3) Participant must not have completed all high school graduation requirements or received a GED. 4) Participant must be in the care of a responsible adult and legal guardian. 5) Participant may not attend college full-time, unless part of a joint enrollment program. 6) Joint enrolled students, please list all high school classes being taken: ______________________ ______________________________________________________________________________ 7) Participant may not be employed full time (40 hours/week) 8) Participant must maintain compliance with their schools attendance policy or comply with Georgia regulations for home school students. 9) Participant is non-eligible of attending: alternative schools, nigh school, trade school, business school, public school, or distance learning school (part of the public school system). 10) Returning participant must have finished the previous season in good standing. If participant dropped out mid-season, he/she must sit out one year before registering. Insurance – Part of your registration will pay for insurance but this is above and beyond your individual policy. In case of an emergency we need the following information: Insurance Company: ____________________________________________________________________ Name of Insured: ______________________________________________________________________ Policy No: _______________________________________ Member No: __________________________ Phone number for insurance company: _____________________________________________________ Private School Students List the name of the school you are attending: _______________________________________________ How long have you attended this school? ___________________________________________________ If less than 2 years, please explain why you chose this school: ___________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ What days and hours are you in School? ____________________________________________________ What degree of parental involvement is required in the participant’s school, school work, etc.? _______ _____________________________________________________________________________________ 7|P a g e Force Cheerleading Registration Form Homeschoolers How long have you home schooled? _______________________________________________________ If participant has been home schooled under 2 years, why did you choose to home school? ___________ _____________________________________________________________________________________ What is your home school style? (i.e. un-school, relaxed, correspondence, classical, etc.) _____________ _____________________________________________________________________________________ What degree of parental involvement does your home school require? ___________________________ _____________________________________________________________________________________ Safety Concerns Our mission is to build Godly men and women through our program. Force Athletics is a Christian organization and we want to provide a positive, safe, nurturing environment for our participants. In doing so, we need to be aware of any and all issues which could post a negative influence on other participants. Please answer the following questions; feel free to go into as much detail as you feel necessary. Your answers will be reviewed by the board members and kept confidential. You may offer further explanations during the personal interview. Students that have been expelled from a public or private school may not participate as a Force player for one year from the time of expulsion. Exceptions may be made under extraordinary circumstances, and must be approved by the Registration Approval Committee. Has your child been expelled from school within the past 2 years? ________ If yes, please explain the circumstances: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Does your child have a police record or are they currently on parole or house arrest? ______ If yes, please explain the circumstances: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 8|P a g e Force Cheerleading Registration Form Parental Involvement Please understand that Force Athletics is a ministry minded organization. Your dedication to the program is paramount to the success of this organization. It is mandatory that all parents work the front gate, concessions and/or serve in another GAME DAY capacity. Are there any limitations as far as scheduling that would prohibit you from volunteering? ____________ _____________________________________________________________________________________ List positions you have held in other programs, and/or any special skills you may have that may benefit this program: _____________________________________________________________________________________ _____________________________________________________________________________________ Involvement is mandatory. Please circle three choices and put a 1, 2 and 3 in order of request. Game Day Fundraising Practice Days Field Setup Pre-game Street fundraisers Cleaning water coolers/bottles Gate Car Washes Ice Coordinator Concessions Soliciting Sponsors Equipment Maintenance Field Cleanup Coordinating Events Cheer Photographer Tailgating Coordinator Box Tops for Education Coordinator Street sign setup and take down Towel washer Water bottle washer Game day coolers wash and bring back Social Homecoming Dance Organizer Bonfire Post-game events Pool Party Family Days Team building events Banquet Other Secure Location Volunteer Coordinator Coaches Gifts Touchdown Club Participant Gifts Program Letters/Bars for Participants Roster Fan Setup/Take down/Decorations Program/Agenda Sponsor Acknowledgement/Plaques Other Positions: Please state whether an MS, JV or Varsity Participant Water boys/girls Publicity – calling in scores to newspapers, writing articles Chain Gang Compassion Ministry (injured participant, family in need, etc.) Announcers and Spotters Directory of Participants Team Chaplain Photographer / Video National Anthem Singers Trainers for Practice and/or Games Statistician Medical Assistance for Practice and/or Games 9|P a g e Force Cheerleading Registration Form Program Expectations I have read the League requirements and the Force Cheerleading Guidelines. I attest that (I am/my participant is) eligible to participate in these programs. I agree to abide by the rules contained therein as administered by the Force Board of Directors. To the best of my knowledge I have truthfully answered the questions on this application. I understand that I will be held accountable for all statements and forms for the Force Athletic Program. I am entitled to copies of such papers, if requested. I acknowledge that the Force Board of Directors has the authority to accept or reject any application. (Participation is not allowed until the Force Board of Directors approves this application.) Participant Signature: __________________________________________________________________ Parent Signature: ______________________________________________________________________ Required Documentation 1) A copy of the current year’s Declaration of Intent to Home School printed from the State of GA website (see below website) or a letter from the student’s school regarding his/her enrollment status 2) Amateur Athletic Waiver Release and Liability Form 3) Birth Certificate 4) Sports Physical (before participating in activity) http://www.gadoe.org/Curriculum-Instruction-and-Assessment/Pages/Home-Schools.aspx 10 | P a g e Football League Cheerleader’s Code of Conduct **Agreement must be signed in conjunction with registration** 1. I understand and agree that my education is my first and foremost responsibility and that I must maintain a Grade Point Average that meets the expectations of my school, my parents and me. 2. I will play any position assigned to me and will do my very best for my team at all times. Coaches determine position placement based on the team, not individual desires. I will support the Board and coaching staff in position placement. 3. I will participate cleanly at all times, in a true sportsmanship-like manner with never any intent to harm a squad member. 4. I will participate in a moment of prayer before practices and games with my coaches and teammates. 5. I will treat my coaches, teammates, parents, teachers, guardians and other individuals I may come in contact with, with respect at all times, on or off of the playing field. 6. I will do whatever my coaches ask me to do to the best of my abilities, at all times. 7. I will refrain from the use of drugs, alcohol and tobacco, on or off the playing field and understand that any violation of this agreement can and will result in suspension from the Georgia Force. 8. I understand that cheerleading is a team sport and that my attendance is required at all practices, games and social gatherings. I will make the commitment to my coaches and teammates to be in attendance and to notify my coach if, for any reason, I am unable to attend any scheduled event. 9. I will not, in any way, damage or deface any property, buildings or equipment. 10. I will abide by the decisions of the Board Members, coaches or leaders and will not create any unsportsmanlike behavior or gestures. 11. I will act as a lady at all times and refrain from any foul or questionable language or discussions on the field, and any social media. 12. I will inform my coach of any injuries I may sustain, on or off of the field. 13. I agree to provide the Head Coach with a doctor’s written explanation of any reason that I cannot participate in practice or a game. A doctor’s written authorization will be required to return to practice. I fully support and understand that Force High School Athletics, Inc. is a ministry organization. All Board Members and Coaches desire to minister to you through cheerleading. By signing this form I agree to abide with this Code of Conduct and the Cheer Guidelines: Signature: ______________________________________________ Date: __________________ Team Name: _____________________________________________ 11 | P a g e Football League Parent’s Code of Conduct **Agreement must be signed in conjunction with registration** 1. I hereby pledge to provide support, care and encouragement for my child participating in the League by following the Parent’s Code of Conduct. 2. I will encourage good sportsmanship by demonstrating positive support for all players, coaches and officials at every game, practice or other sporting event. 3. I will place the emotional, physical and spiritual well-being of my child ahead of my personal desire. 4. I will insist that my child play in a safe and healthy environment. 5. Coaches determine position placement based on the team, not individual desires. I will support the Board and coach staff in position placement. 6. I will require that my child’s coaches be trained in the responsibilities of being a high school sports coach and that the coaches uphold the Coach’s Code of Conduct. 7. I will support the coaches and officials working with my child, in order to encourage a positive and enjoyable experience for all. 8. I will demand a sports environment for my child that is free from drugs, alcohol, tobacco and profanity. I will refrain from all uses at all high school sports events. 9. I will remember the game is for the students – not the adults 10. I will do my very best to make high school sports fun for my child. 11. I will demand my child to treat other players, coaches, fans and officials with respect, regardless of race, sex, creed, color or ability. 12. I will inform my child’s coach should she sustain any potentially serious injuries, associated or not, with her participation in the League. 13. I will volunteer to assist in whatever capacity I am able. 14. I agree to provide the Head Coach with a doctor’s written explanation of any reason that I cannot participate in practice or a game. A doctor’s written authorization will be required to return to practice. 15. I agree to provide the Head Coach with a doctor’s written explanation of any reason that I cannot participate in practice or a game. A doctor’s written authorization will be required to return to practice. 16. I agree to call the Head Coach if I determine that my child is sick and cannot participate. I fully support and understand that Force High School Athletics, Inc. is a ministry organization. All Board Members and Coaches desire to minister to you through cheerleading. By signing this form I agree to abide with this Code of Conduct and the Cheer Guidelines: Signature: ______________________________________________ Date: __________________ 12 | P a g e Waiver/Release Amateur Athletic Waiver and Release of Liability Read before signing In consideration of being allowed to participate in any way in the League and on the Georgia Force football team, in any related events and activities, the undersigned acknowledges, appreciates and agrees that: 1. The risk of injury from the activities involved in this program is significant, including the potential for minor, major and life threatening injuries, while particular rules, equipment, and personal discipline may aid in reducing the risk, the potential risk of serious and life threatening injury does exist: and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF RISING FROM THE NEGLIGENCE OF THE RELEASEES, or others, and assume full responsibility for participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS, the League, Georgia Force football team, any coach, team member or team volunteer as well as Gary Pirkle Park/Sugar Hill, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lesser of premises used to conduct any event or practice, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, LIFE THREAT, or the loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEE OR OTHERWISE. I HAVE READ AND UNDERSTAND THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT. I FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. ________________________________________________________ Participants Signature ___________________________ Date Signed FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent to his/her release as provided above of all the Releases, and for myself, my heirs, assigns, and next of kin, I release, agree to indemnify and hold harmless the above Releases from any and all liabilities incident to my minor child’s involvement of participation in these programs as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE. ________________________________________________________ Parent/Guardian Signature ___________________________ Date Signed ____________________________ Emergency Phone Number 13 | P a g e Parent Approval Form General Medical Release – Required form for Minors Applicant Name: _______________________________________________________________________________ The medications listed below are over-the-counter (OTC) medications that may be carried by the Force Staff. Please check the boxes to confirm that they may be given as indicated: 1. Triple Antibiotic Ointment as needed for minor wounds Yes No 2. Hydrocortisone Cream as needed for skin irritation Yes No 3. Ibuprofen 200 mg 1 or 3 tablets every 6 hours as needed for pain or fever Yes No Icy/Hot (muscle rub) – Menthol 2.5% as needed for muscle aches Yes No Antacid Tablets 1 or 2 tablets every 4 hours as needed for leg cramps, heartburn, indigestion Yes No 6. Benadryl 1 or 2 tablets as needed for allergic reaction Yes No 7. Allergy Topical Ointment as needed for insect bites Yes No 4. 5. List any allergies: _______________________________________________________________________________ List any medical conditions and explain: _____________________________________________________________ _____________________________________________________________________________________________ I give my consent to the administration of over-the-counter (OTC) medication to my minor child as indicated above. I also give my consent for Force High School Athletics, Inc. (FHSA) board members, coaches and athletic trainers, if I am not present during any FHSA sponsored event, to make the necessary decisions for my child’s medical care, to include calling 911 and/or any other treatment deemed necessary to care for my child. _________________________________________________________________________________ ________________________________________________________ Parent/Guardian Signature ___________________________ Date Signed ________________________________________________ Printed Name 14 | P a g e Georgia Force High School Athletics, Inc. Photo Release Form Permission to Use Photograph Event: 2015 Football Season, games, parties and events I grant to Force High School Athletics, Inc. (Georgia Force), the right to take photographs of me and my family in connection with the above-identified event. I authorize Force High School Athletics, Inc. (Georgia Force), its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Force High School Athletics, Inc. (Georgia Force) may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. Also, I give permission for a photograph of me and my son/daughter to be taken at registration. I have read and understand the above: _________________________________________________________________________ Player/Cheerleader’s Name _________________________________________________________________________ Signature _________________________________________________________________________ Printed Name _________________________________________________________________________ Street Address _________________________________________________________________________ City, State, Zip __________________________ Date _________________________________________________________________________ Parent/Guardian Signature (if under 18) 15 | P a g e
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