FOOTBALL & CHEERLEADING
CLINIC REGISTRATION FORM

Clinic at Bradford High School at 519 North Orange Street Starke, FL
This clinic certification expires after the 2013 season.

Remember that recertification clinics for Football can be taken online this year.
Please visit the training page on Putnam's site for additional information.

A $15 late fee will be assessed for anyone who is not pre-registered,
pre-registration closes at midnight, July 20, 2011.

Attendant's Name (first & last):
Phone with Area Code:
Email:
Address:
	City: , FL   zip:
Title:	Select One Head Coach Assistant Coach Coordinator Other, please explain in comments
Clinic Type:	Select One Football Clinic $45 Cheerleading Clinic $55 Cheer - Hands on Recertification $25
Putnam Association:	Select One Bradford County Gainesville Lake City Lake Region NW Volusia Palatka Santa Fe South Putnam Suwanee Dog Pound Union County West Putnam Other League, please complete next section
If you are not in the Putnam Athletic League, please complete this section.
League Name:	Big Bend First Coast Foundation for Youth Greater Jacksonville Greater Miami Northwest Panhandle Mid-Florida Peace River Timucua Treasure Coast
Association Name:

Comments:

Registration Fees: Football Clinic $45* July 23 Cheerleading Clinic $55* July 23 & 24 Cheerleading Hands-On Recertification $25* July 23 *A $15 late fee will be assessed at the door for all participants who are not pre-registered.

Method of Payment:

A $15 late fee will be assessed at the door for all participants who are not pre-registered. Any checks that are returned for insufficent funds will be subject to a $35 service charge.

By submitting this form you hereby agree to the terms of this agreement. You also take responsibility for payment of all fees. Fees are non-refundable, and by submitting this form you take full responsibility for payment.

I agree to the terms listed above.   

 

 

Putnam Athletic League  |  www.putnamathleticleague.com   |   15406 NW 202nd Street, Alachua, FL 32615