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Child Information

First Name: Last Name: Sex: Date of birth:
Address: City: State Zip:
Phone: School: Basketball:
Cheerleading:
Both

Uniform Size:
1st Emergency Contact: Phone Number:
2nd Emergency Contact: Phone Number:
Medical or physical restrictions:
Parent / Guardian: Home Phone: Cell Phone: Work Phone:
Parent / Guardian: Home Phone: Cell Phone: Work Phone:
Email:

After dismissal, child is allowed to be released to:

1st Contact: Phone Number:
2nd Contact: Phone Number:
3rd Contact: Phone Number:
  Does child has permission to go home alone?

Player Profile Information

Height:     Weight:    
Favorite School Subject:
Favorite Movie / TV Show:
Favorite Musical Artist:
Favorite Food:
Favorite Team / Player:
Role Model:
Other Interests:
Future Job / Career
(other than basketball or cheerleading):

 

Gladiator Sports, Inc.
Salvation Army * 540 Lenox Avenue * Harlem, NY 10037
Directions to Gladiator Sports
646-213-1373
info@gladiatorsports.org

® Gladiator Sports and The Gladiator Sports logo are registered trademarks of Gladiator Sports Inc.