Name: 

Street Address:   

City, State ZIP    

Age:  2 3 4         Gender:  Male Female         T-Shirt Size:  Youth XSmall (3-5) Youth Small (6-8) Youth Medium (10-12) Youth Large (14-16) Adult Small Adult Medium Adult Large Adult XLarge

Birth Date: (MM/DD/YYYY)

Parent or Guardian Name:   

Contact Phone Number:      

Alt Emergency Contact Name: 

Alt. Emergency Phone Number: 

Email Address: 

Physical Limitations: 

Where did you hear about Audience 1 Sports : Newspaper Radio Advertisment Flyer Web Site Friend School Email Facebook Other

 You can pre order the same shirt design your child will be receiving. The purchase can be added to the registration fee. Available styles and prices are:

• T-Shirt -$10.00(each)

• Sweatshirt -$20.00(each)

• Hooded Sweatshirt -$25.00(each)

First Apparel Selection For Purchase: None T-Shirt($10) Sweatshirt($20 each) Hooded Sweatshirt($25)   Quantity: 1     Size:   None Adult Small Adult Medium Adult Large Adult XLarge Adult XXLarge

Second Apparel Selection For Purchase: None T-Shirt($10) Sweatshirt($20 each) Hooded Sweatshirt($25)   Quantity: 1     Size:   None Adult Small Adult Medium Adult Large Adult XLarge Adult XXLarge

Third Apparel Selection For Purchase: None T-Shirt($10) Sweatshirt($20 each) Hooded Sweatshirt($25)   Quantity: 1     Size:   None Adult Small Adult Medium Adult Large Adult XLarge Adult XXLarge

 You can order Dinomite Shingards size (XXS Only) for your child his/her use . The purchase can be added to the registration fee:

Dinomite Shinguard purchase: No Yes Size(XXS only)($15)   Quantity: 1

Note: Please add the total for Additional Apparel Purchases into the registration fee check.

 

Make Checks Payable To: Audience 1 Sports, INC
Mail Payment To: 508 Fern Drive
                        Campbellsville, KY 42718

 *NOTE: Liability Release Form MUST Accompany Payment

Liability Form Please right click on link and choose "Save Target As" to download .doc file

Contact Email Address: jasonengland@audience1sports.com