Facility Usage Contact Card — Westmont Cheer 2024-2025

Facility usage - cheer program

emergency Contact Card

Name of Participant

First Name

Last Name

Birth Date of Participant

MM

DD

YYYY

Enrolled School for 2023-2024

Elementary, Middle or High School

Participant: Cell Number (if applicable)

(###)

###

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Parent/Guardian #1

First Name

Last Name

Parent/Guardian #1 (Relation to participant)

Parent/Guardian #1: Phone Number

(###)

###

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Parent/Guardian #2

First Name

Last Name

Parent/Guardian #2 (Relation to participant)

Parent/Guardian #2: Phone Number

(###)

###

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Participant: Primary Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

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