LSA Spirit Squad

Participant Name

Age

Current School

Parents's Name

Parent Employment

Address

Phone Number

2nd Phone

Email Address (Mom)

Email Address (Dad)

Special Instructions/Health Concerns

Please check one of the below boxes:

I give my permission to LSA to use my athlete’s name and/or photo in any advertisement or publication in relation to LSA. I DO NOT give my permission to LSA to use my athlete’s name and/or photo in above mentioned advertisement or publications.

LSA Spirit Squad

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