LONG ISLAND KICKLINE ASSOCIATION – L.I.K.A., INC.

APPLICATION FOR COMPETITIONS 2011-2012 SEASON

 

THIS FORM AND YOUR 2011-2012 SCHOOL INSURANCE CERTIFICATE (IN THE AMOUNT OF $2 MILLION WITH LIKA INC. LISTED AS ADDITIONAL INSURED) MUST BE ON FILE WITH LIKA ON OR BEFORE NOVEMBER 23, 2011. INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. 

 

SCHOOL NAME:                                                     TEAM NAME:                                                                      

 

ADVISOR’S NAME:                                                  HOME PHONE:                                                                

 

ADVISOR’S ADDRESS:__________________________________________________________  

 

ADVISOR’S TOWN___________________________________   ZIP:                                                      

 

ADVISOR’S E-MAIL: ____________________________ CELL PHONE: _________________

 

NAME/TITLE, PHONE AND EMAIL ADDRESS OF DISTRICT ADMINISTRATOR IN CHARGE OF ACCOUNTS PAYABLE:

 _______________________________________________________________________________

 

_______________________________________________________________________________

 

CAPTAINS NAMES: ­­­­­­­­­­­­­­_______________________________________________________________

 

LIKA DIVISIONS YOU WILL BE ENTERING/NUMBER OF MEMBERS ON THE SQUAD:

(If you fall 4 or more members below the number you declare, a penalty of .1 member will be applied.  Don’t include any alternates.  Going over the size per class results in disqualification.) 

CHECK ONE OR MORE                                        # OF MEMBERS     

o High Kick                                                   ______

o Dance                                                         ______

o Pom                                                            ______

o Step                                                             ______

o Hip Hop                                                      ______

Classes are determined based on declarations.

 

L.I.K.A. Contests for 2010-2011.  Check all you are planning to enter. 

Events                                                                                   Division(s) Entering

(   )  December 18, 2011      (  )  Kick   (  )  Dance  (  )  Pom   (   ) Step  (  ) Hip Hop

(   )  January 15, 2012         (  )  Kick   (  )  Dance  (  )  Pom   (   ) Step  (  ) Hip Hop

(   )  February 12, 2012        (  )  Kick   (  )  Dance  (  )  Pom   (   ) Step  (  ) Hip Hop

 

·         Entrance fee for each division entered, in each contest is $180.00, except the Invitational Championship, which is $185.00. Spectator’s Fee is $7.00 collected at the door.  *to be held on March 11, 2012.