*Required fields.

Personal Information

First Name *

Last Name *

Street Address *

City *

State *
Select State or Commonwealth/Territory
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Cell Phone Number *
Please provide the cell phone number of the primary contact person regarding cheerleading information.

E-Mail *
Please enter the primary contact person's email address.

Date of Birth *
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Facebook *
Paste the URL from your Facebook profile

Twitter
Type username, if applicable. If not, type "none".

Height *

Weight *
Weight in lbs.

Gender *
Male
Female
Other:

Why San Josà © State Cheerleading? *

Parent(s)/Guardian Information

Parent/Guardian's Name *

Guardian's Street Address *
If different from your own.

City *

State *
Select State or Commonwealth/Territory
ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNHNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYASDCFMGUMHMPPWPRVI

Guardian's Phone Number *

Guardian's E-Mail *

Academic Information

High School or Current School Attending *

Graduation Date *
Approximate
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Current GPA (Grade Point Average) *

Combined SAT Score
If Applicable

Combined ACT Score
If Applicable

San Josà © State Information

Date Applied *
Approximate
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Date Accepted
If Applicable
JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember   12345678910111213141516171819202122232425262728293031   2016201520142013201220112010200920082007200620052004

Tower ID
If one has already been assigned to you.

Cheer Information

Years of Cheerleading Experience *

Highest All-Star Level Competed *
1
2
3
4
4.2
5
6
No All-Star Experience

Highest High School Level Competed *
Novice
Intermediate
Advanced
No High School Cheerleading Experience

Squad Type *
Select the one that you have most experience with.
Co-Ed
All-Female

Stunt Position *
Check All That Apply
Back
Base
Top
Front

Squads Currently A Member Of *

Coach(es) Name(s) *

Coach(es) E-Mail(s) *

Coach(es) Phone Number *

Best Standing Tumbling Skill *
(i.e. back hand spring full)

Best Running Tumbling Skill *
(e.g. arabian through to double)

Best Stunting Skill *
Use this format: Type of mount, Body position in the air, Type of dismount. (e.g. Full up, stretch, double down)

Injuries/Surgeries Suffered *

References

Please list 3 references that you have worked with in a professional setting.

Reference 1 *

Phone Number 1 *

E-Mail 1 *

Reference 2 *

Phone Number 2 *

E-Mail 2 *

Reference 3 *

Phone Number 3 *

E-Mail 3 *

Other Information

How Did You Find Out About San Josà © State Cheerleading? *

Comments or Questions

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