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St. Jerome Athletic Association’s 40th Annual - page 2 / 3

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ST. JEROME TOURNAMENT OF STARS TEAM ROSTER FORM

YEAR

SPORT

BOYS

GIRLS

GRADE

SCHOOL & MASCOT

CITY

PLEASE TYPE OR PRINT

PLAYER NAME

BIRTHDATE

AGE

GRADE

STUDENT

SCHOOL    CCD**

SCHOOL ATTENDING

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

Parish based programSchool based program

We certify that we are VIRTUS compliant.

Coach’s Name _________________ Home Phone/Cell ___________________ E-mail Address ______________________________

“All players listed conform to all eligibility rules, all coaches have satisfied the certification requirements, and the team and athletic program at the parish/school are in compliance with all current Archdiocese of Milwaukee Policies & Procedures for Athletics.”

COACH’S SIGNATUREDateATHLETIC DIRECTOR SIGNATUREDate

__________________________________________________               __________________________________________________

PASTOR or PRINCIPALSIGNATUREDate              DRE/CYF DIRECTOR SIGNATUREDate

IMPORTANT:  List the dates/times of any possible conflicts on the back of this entry form; we will try to work around your conflicts when preparing the pairings.OVER -------------

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