Pride Cheerleading
&
Registration and
Release Form
1st Child Name_______________________ E-Mail______________________
Student’s DOB: ____/____/_____ School_____________________
Current Grade in School______
2nd Child Name_______________________ E-Mail______________________
Student’s DOB: ____/____/_____ School_____________________
Current Grade in School______
3rd Child Name_______________________ E-Mail______________________
Student’s DOB: ____/____/_____ School_____________________
Current Grade in School______
Mother’s Name ________________________
Father’s Name _____________________________
E-Mail Address ________________________
Home Phone #________________________
Cell Phone # ________________________
Address
_________________________________________________________________
Mother's Employment: _________________
Father's Employment: ___________________
Mother's Work #: ___________________
Father's Work #: _______________________
In an emergency, please contact___________________
Phone_______________
INSURANCE INFORMATION
Each participant is required to have insurance to participate.
Please list your insurance information below.
Company_____________________________ Policy/ Group
#_________________
Address___________________ City _____________ State________
Zip_________
Note: Please list any
allergies and/or medication that the participant is currently taking.
I fully understand that Pride Cheerleading staff
members are not physicians or medical practitioners of any kind. With the above
in mind, I hereby release the Pride Cheerleading staff to render temporary
first aid to my child or children in the event of any injury or illness, and if
deemed necessary by the Pride Cheerleading staff, to call our doctor and to
seek medical help, including transportation by a Pride Cheerleading member and
or its representatives, whether paid or volunteer, to any health care facility
or hospital, or the calling of an ambulance for said child should the Pride
Cheerleading staff deem it necessary.
We,
the staff of Pride Cheerleading recognize our obligation to make our students and
their parents aware of the risks and hazards associated with the sport of
cheerleading. Students may suffer injuries, possibly minor, serious or
catastrophic in nature. These activities can be dangerous and can lead to
injury or even death!
Parents
should make their children aware of the possibility of injury and encourage
their children to follow all the safety rules and the coaches' instructions.
Pride
Cheerleading, its coaches and other staff members, will not accept
responsibility for injuries sustained by any student during the course of
tumbling, stunting, cheerleading, camps or clinics in which he or she may
participate or while traveling to or from the event.
With
the above in mind, and being fully aware of the risks and possibility of injury
involved, I consent to have my child or children participate in the programs
offered by Pride Cheerleading. I, my executors or other representatives, waive
and release all rights and claims for damages that I or my child may have
against Pride Cheerleading and or its representatives whether paid or
volunteer.
I
also affirm that I now have and will continue to provide proper
hospitalization, health and accident insurance coverage which I consider
adequate for both my child's protection and my own protection.
I
also understand that it is the parents' responsibility to warn the child about
the dangers of cheerleading and injury. The parent should warn the child
according to what the parent feels is appropriate. Pride Cheerleading will only
warn the child through “Safety Messages” and our teaching style and
progressions.
Past due balances shall be assessed a service charge or interest
at the highest rate allowed by law until payment is made. If any indebtedness
due and owing is not paid as agreed herein, the undersigned agrees to
pay/reimburse to Pride Cheerleading its reasonable attorney fees and
costs incurred whether suit is instituted or not, should Pride
Cheerleading refer its claim to an attorney to collect the indebtedness
due and owing. Should suit be instituted for any indebtedness due and owing to
Pride Cheerleading, you consent to venue being in
X
________________________________________ __________________
Parent
or Legal Guardians Signature if under (18) Date