Cheerleading Registration Form
Participant Information:
Full Name: _______________________________________________
Date of Birth: ____________________________________________
Address: _________________________________________________
City: _________________________ State: _______ Zip: ________
Phone Number: ___________________________________________
Email Address: ___________________________________________
Emergency Contact Information:
Emergency Contact Name: __________________________________
Relationship to Participant: __________________________________
Phone Number: ___________________________________________
Medical Information:
Does the participant have any medical conditions/allergies? [ ] Yes [ ] NoIf yes, please specify: _______________________________________
Does the participant take any medication? [ ] Yes [ ] NoIf yes, please specify: _______________________________________
Insurance Information:
Insurance Provider: _________________________________________
Policy Number: ___________________________________________
Parent/Guardian Consent:
I, the undersigned parent/guardian, hereby give consent for my child to participate in the cheerleading program. I understand that there are inherent risks involved in physical activities and agree to release the organizers, coaches, and sponsors from any liability for injuries sustained during participation.
Parent/Guardian Signature: _________________________________
Date: ________________________
Registration Fee:
Participant Information:
Full Name: _______________________________________________
Date of Birth: ____________________________________________
Address: _________________________________________________
City: _________________________ State: _______ Zip: ________
Phone Number: ___________________________________________
Email Address: ___________________________________________
Emergency Contact Information:
Emergency Contact Name: __________________________________
Relationship to Participant: __________________________________
Phone Number: ___________________________________________
Medical Information:
Does the participant have any medical conditions/allergies? [ ] Yes [ ] NoIf yes, please specify: _______________________________________
Does the participant take any medication? [ ] Yes [ ] NoIf yes, please specify: _______________________________________
Insurance Information:
Insurance Provider: _________________________________________
Policy Number: ___________________________________________
Parent/Guardian Consent:
I, the undersigned parent/guardian, hereby give consent for my child to participate in the cheerleading program. I understand that there are inherent risks involved in physical activities and agree to release the organizers, coaches, and sponsors from any liability for injuries sustained during participation.
Parent/Guardian Signature: _________________________________
Date: ________________________
Registration Fee: