2013 Dare to Cheer Registration Form

CIRCLE CLINIC TIME PREFERENCE: AM 9:00 am to 11:30 am or PM 12:30 pm to 3:00 pm

Dare to Cheer Member Name: Full Address:

(including city, zip)

Home Phone: E-mail:

Cell Phone:

All JDBC correspondence is e-mailed!!! Please feel free to provide multiple e-mails for your convenience.

Age: Parents Names: Siblings in JDBC:

DOB:

Emergency contact (other than cell phone listed above): _________________________________________________________________ _____
For office use when you arrive to be fitted for your uniform: Uniform Costs: Uniform Tax Uniform Total Optional Tuition: $ _____ $_________________(add an additional 7.62% to your uniform total) $_________________ $ ______($283 for entire season with 10% discount)

TOTAL: Cash Credit Card (Visa or MC) Card #

$ $ Name: Exp. Code