ST. CYRIL OF JERUSALEM
ATHLETIC MEMBERSHIP APPLICATION
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Family Address
Primary Family Address
Family Name
Address
Father's Name
Mother's Name
Maiden Name
Guardian's Name
Primary E-mail
This will be the main e-mail address we will use to communicate with your family.
Primary Phone
This will be the main phone number we will use to communicate with your family.
Parish
Total Number of Children
1
2
3
4
5
Total number of children you will be registering today
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Fees:
3rd - 4th grade $50
5th -
8th grade $100
9th thru 12th grade $120
Child 1
Name
Gender
Male
Female
Date of Birth
Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
School
Medical/Allergy Data
Enrolled in PREP?
Yes
No
Child 2
Name
Gender
Male
Female
Date of Birth
Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelth Grade
School
Medical/Allergy Data
Enrolled in PREP?
Yes
No
Child 3
Name
Gender
Male
Female
Date of Birth
Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
School
Medical/Allergy Data
Enrolled in PREP?
Yes
No
Child 4
Name
Gender
Male
Female
Date of Birth
Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
School
Medical/Allergy Data
Enrolled in PREP?
Yes
No
Child 5
Name
Gender
Male
Female
Date of Birth
Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
School
Medical/Allergy Data
Enrolled in PREP?
Yes
No
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Terms of Service
I, the parent or guardian, of the above named child, hereby give my approval to their participation in any and all activities of the above activity during the current season. I assume all risks and hazards incidental to the conduct of the activities and transportation to and from the activities. I do hereby release, absolve, indemnify and hold harmless St. Cyril of Jerusalem Parish, Jamison, the Administrators, the Supervisors, the Officers, the Sponsors, and/or all of them. In case of injury to my child, I hereby waive all claims against the Sponsors, the Officers, or any Administrators or Supervisors appointed by them, and also give my permission for any necessity emergency medical treatment to be administered. I likewise waive, to the extent not covered by liability or accident insurance, any claim against any person transporting my child to and from activities. I will furnish a birth certificate of the above named child upon request of Association Officials.
I do have medical/accident insurance coverage
I do NOT have medical/accident insurance coverage
I understand that by signing the Membership Application of St. Cyril's I have agreed and acknowledged that St. Cyril's CYO is including the said applicant in their plans and that I am indebted to St. Cyril's CYO for the non-refundable registration fee.
I agree
It is further agreed that this fee is non-refundable if the said applicant is suspended or removed for team discipline, school discipline or academic reasons.
I agree
Total Amount
Verification
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Calculate
SUBMIT FORM AND PAY