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Pennsylvania Cross Country Skiers Association
developing the sport of nordic skiing in PA and its tri-state region
Yellowjackets online registration
PACCSA Yellowjackets Registration Form - Season 2025
Parent Contact Information
Parent's name (First and Last)
*
Address
*
City
*
State
*
Zip code
*
Phone number
*
### ### ####
Email address
*
Children Information
Child 1
Child name (First and Last)
*
Date of Birth
*
Year
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
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1971
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1974
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1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
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1995
1996
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1998
1999
2000
2001
2002
2003
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2007
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2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
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4
5
6
7
8
9
10
11
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13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
year - month - day
Gender
*
Male
Female
Other
New
*
Yes
No
Is this child new to the Yellowjackets Program?
Level / Program
*
Bunnyrabbit
Jackrabbit
Track Attack
Health Insurance Information
Provider
*
Phone Number
*
### ### ####
Policy Holder's name
*
Policy Number
*
Doctor Information
Doctor or Pediatric Practice
*
Phone Number
*
### ### ####
Emergency Contact
Emergency Contact 1
Name (First and Last)
*
Main emergency contact
Relationship with child
*
Phone number
*
### ### ####
Emergency Contact 2
Name (First and Last)
Relationship with child
Phone number
### ### ####
Allergies
Please specify allergies and list of reactions, if applicable
Other Health or Behavioral Concerns
Please specify any other health or behavioral concerns, if applicable
Child 2
Child name (First and Last)
Date of Birth
*
Year
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
year - month - day
Gender
*
Male
Female
Other
New
*
Yes
No
Is this child new to the Yellowjackets Program?
Level / Program
*
Bunnyrabbit
Jackrabbit
Track Attack
Health Insurance Information
Same as child 1
*
Yes
No
Provider
Phone Number
### ### ####
Policy Holder's name
Policy Number
Doctor Information
Same as child 1
*
Yes
No
Doctor or Pediatric Practice
Phone Number
### ### ####
Emergency Contact
Same as Child 1
*
Yes
No
Emergency Contact 1
Name (First and Last)
Main emergency contact
Relationship with child
Phone number
### ### ####
Emergency Contact 2
Name (First and Last)
Relationship with child
Phone number
### ### ####
Allergies
Please specify allergies and list of reactions, if applicable
Other Health or Behavioral Concerns
Please specify any other health or behavioral concerns, if applicable
Child 3
Child name (First and Last)
Date of Birth
*
Year
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
year - month - day
Gender
*
Male
Female
Other
New
*
Yes
No
Is this child new to the Yellowjackets Program?
Level / Program
*
Bunnyrabbit
Jackrabbit
Track Attack
Health Insurance Information
Same as child 1
*
Yes
No
Provider
Phone Number
### ### ####
Policy Holder's name
Policy Number
Doctor Information
Same as child 1
*
Yes
No
Doctor or Pediatric Practice
Phone Number
### ### ####
Emergency Contact
Same as Child 1
*
Yes
No
Emergency Contact 1
Name (First and Last)
Main emergency contact
Relationship with child
Phone number
### ### ####
Emergency Contact 2
Name (First and Last)
Relationship with child
Phone number
### ### ####
Allergies
Please specify allergies and list of reactions, if applicable
Other Health or Behavioral Concerns
Please specify any other health or behavioral concerns, if applicable
Child 4
Child name (First and Last)
Date of Birth
*
Year
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
year - month - day
Gender
*
Male
Female
Other
New
*
Yes
No
Is this child new to the Yellowjackets Program?
Level / Program
*
Bunnyrabbit
Jackrabbit
Track Attack
Health Insurance Information
Same as child 1
*
Yes
No
Provider
Phone Number
### ### ####
Policy Holder's name
Policy Number
Doctor Information
Same as child 1
*
Yes
No
Doctor or Pediatric Practice
Phone Number
### ### ####
Emergency Contact
Same as Child 1
*
Yes
No
Emergency Contact 1
Name (First and Last)
Main emergency contact
Relationship with child
Phone number
### ### ####
Emergency Contact 2
Name (First and Last)
Relationship with child
Phone number
### ### ####
Allergies
Please specify allergies and list of reactions, if applicable
Other Health or Behavioral Concerns
Please specify any other health or behavioral concerns, if applicable
Child 5
Child name (First and Last)
Date of Birth
*
Year
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
year - month - day
Gender
*
Male
Female
Other
New
*
Yes
No
Is this child new to the Yellowjackets Program?
Level / Program
*
Bunnyrabbit
Jackrabbit
Track Attack
Health Insurance Information
Same as child 1
*
Yes
No
Provider
Phone Number
### ### ####
Policy Holder's name
Policy Number
Doctor Information
Same as child 1
*
Yes
No
Doctor or Pediatric Practice
Phone Number
### ### ####
Emergency Contact
Same as Child 1
*
Yes
No
Emergency Contact 1
Name (First and Last)
Main emergency contact
Relationship with child
Phone number
### ### ####
Emergency Contact 2
Name (First and Last)
Relationship with child
Phone number
### ### ####
Allergies
Please specify allergies and list of reactions, if applicable
Other Health or Behavioral Concerns
Please specify any other health or behavioral concerns, if applicable
Child 6
Child name (First and Last)
Date of Birth
*
Year
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
year - month - day
Gender
*
Male
Female
Other
New
*
Yes
No
Is this child new to the Yellowjackets Program?
Level / Program
*
Bunnyrabbit
Jackrabbit
Track Attack
Health Insurance Information
Same as child 1
*
Yes
No
Provider
Phone Number
### ### ####
Policy Holder's name
Policy Number
Doctor Information
Same as child 1
*
Yes
No
Doctor or Pediatric Practice
Phone Number
### ### ####
Emergency Contact
Same as Child 1
*
Yes
No
Emergency Contact 1
Name (First and Last)
Main emergency contact
Relationship with child
Phone number
### ### ####
Emergency Contact 2
Name (First and Last)
Relationship with child
Phone number
### ### ####
Allergies
Please specify allergies and list of reactions, if applicable
Other Health or Behavioral Concerns
Please specify any other health or behavioral concerns, if applicable
PACCSA Membership Information
Family Membership
Number of adults
0
1
2
3
4
5
6
7
8
9
Number of children
0
1
2
3
4
5
6
7
8
9
Email Group
Check if you would like to join the e-mail group for PACCSA members.
Alternative Email
Please supply an email address for PACCSA to use for official communication and newsletter. Leave empty if it is the same as in Parent Contact Information.
Volunteer opportunities
PACCSA needs volunteers! Let us know how you can help.
PACCSA Release Information
PACCSA Yellowjackets Waiver and Release
Please review the document before submitting your information.
This is to certify that as the parent/legal guardian of the identified minor(s), I do hereby agree, achnowledge and consent, for myself and my minor(s), to be bound by each of the terms and conditions identified in the document linked above
Date
*
Year
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
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year - month - day
Name
*
Leave this field blank
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