Cheer/Dance Team Recruiting Form

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First Name: *

Last Name: *

Email address *

Address: *

Phone Number: *

City: *

State: *

Zip Code: *

Date of Birth:

Gender:

Male Female

Parent/Guardian #1 Name

Parent/Guardian #1 Phone Number:

Parent/Guardian #1 Email:

Parent/Guardian #2 Name

Parent/Guardian #2 Phone Number:

Parent/Guardian #2 Email

Graduation Year:

High School/College:

Street Address:

State:

Zip Code:

Country:

GPA:

SAT Total:

ACT:

Academic Honors:

Intended Major:

Have You Applied to Central Community College?

Yes No

Athletic

Height Feet/Inches:

High School Cheer/Dance Coach's Name:

High School Cheer/Dance Coach's Email:

Years on the High School Dance/Cheer Team:

Have you had Cheer/Dance Studio Training?

Yes No

If Yes, What is the Cheer/Dance Studio Name:

Have you ever Participated in Choreographing for Your Cheer/Dance Team or Studio?

Yes No

Student Electronic Signature - Please type your First and Last Name: *

Date: *

* required field