Participants First Name: Participants Last Name:
Address: City: Telephone:
Football City: American Canyon Antioch Bears of San Ramon Benicia Clayton Valley Concord Deer Valley East County Livermore Martinez Napa Pleasant Hill San Leandro San Ramon T-Birds Solano Walnut Creek West County West Pittsburg (choose one) Level : Mascot Scout Jr. Pee Wee Pee Wee Jr. Midget Midget (choose one)
Parent or Guardians Name: Drop Date:
Please provide an explanation why this participant is being dropped from your cities roster. Any appropriate documentation should be attached.
President Name: email:
Head Coach / Cheer Coordinator Name: email: