February 6, 2003



POP WARNER LITTLE SCHOLARS, INC

TEMPLATE ID CARD

2019 SEASON

|PARTICIPANT INFORMATION CHEER DANCE FOOTBALL FLAG | |

| |ATTACH PHOTO HERE |

| |PHOTO MAY BE NO MORE THAN TWO YEARS OLD |

| |PHOTO MUST HAVE OVERLAPPING |

| |OFFICIAL SEAL |

|DIVISION OF PLAY (check one) |TM MM JPW PW JV | |

| |V JB B UNLIMITED CHALLENGER | |

| |Coach Trainee Mascot | |

|Weight at 1st Practice _________ |Student Demonstrator Water Boy | |

|Last Name, First Name Middle Initial | |

|      | |

|Address (city, State, Zip Code) | |

|      | |

|Home Phone |Work/Emergency Phone | |

|      |      | |

|Association /League |Home Jersey Number & Color |Away Jersey Number & Color | |

|      /       |      |      | |

|LEAGUE CERTIFICATION OFFICIAL |

|___________________________ ______________________________ |

|League Signature Association |

|Release |

| | | | | | | | |

| | | | |Certified Weight |Cheer Certified | |Reclassified Date |

|Date of Birth |Age as of 07/31 |O/L |Medical |& Date |Insert Date |Scholastics | |

| | | | | | | | |

| | | | | | | | |

| | | | | | | | |

|TO THE BEST OF MY KNOWLEDGE AND BELIEF, I CERTIFY THAT THE INFORMATION ABOVE IS TRUE. |

|Signature and date of Certifying Official: |

| | | |(P) Pass | | | |(P) Pass |

|rEGULAR sEASON |Game Date |Weigh Master’s certification |(F) Fail |pOST |Game Date |Weigh Master’s Certification |(F) Fail |

| | | |(D) DNW |sEASON | | |(D) DNW |

| | | |P | | | |P |

| | | |F |10th Game | | |F |

|1st Game | | |D |Play Offs | | |D |

| | | | |2nd Round | | | |

| | | |P | | | |P |

| | | |F |Play Offs | | |F |

|2nd Game | | |D |3rd Round | | |D |

| | | |P | | | |P |

| | | |F |League FB | | |F |

|3rd Game | | |D |Championship | | |D |

| | | |P | | | |P |

| | | |F |League Spirit | | |F |

|4th Game | | |D |Championship | | |D |

| | | |P | | | |P |

| | | |F |Regional Semi-Finals | | |F |

|5th Game | | |D | | | |D |

| | | |P | | | |P |

| | | |F |Regional Semi-Finals | | |F |

|6th Game | | |D | | | |D |

| | | |P | | | |P |

| | | |F |Regional Championship| | |F |

|7th Game | | |D | | | |D |

| | | |P | | | |P |

| | | |F |National Championship| | |F |

|8th Game | | |D | | | |D |

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