Cheer Camp Registration Form

To ensure proper form submission, all boxes must be filled

Camper First Name:

Camper First Name

Camper Last Name

Camper Last Name

Camper T-Shirt Size (Youth Small, Youth Medium, Youth Large, Adult Small, Adult Medium, Adult Large

YS,YM,YL,AS,AM,AL

Rising Grade Level:

K,1, 2, 3, 4, 5, 6, 7, 8, 9

Current School attending:

Current School Attending

Parent # 1 Full Name

Parent #1 Full Name

Parent #1 Phone Number

parent number #1 Phone number

Parent #2 Full Name

Parent #2 Full Name

Parent # 2 Phone Number:

Parent #2 phone number

Parent Email:

Parent #1 Email

Street Address:

Street Address Line 1

Street Address Line 2

Street Address Line 2

City:

City

County

County

Postal/Zip Code

Zip Code

Emergency Contact Name(other than parent)

Emergency Contact

Emergency Contact Phone Number:

Emergency Contact phone number

Existing Medical Conditions:

Existing medical conditions

Camp Sibling(s) Name(s) and rising grade level(s). Please list both as it helps us locate siblings quickly, if needed, during camp time.

Sibling's name(s) and grade level

Attending with a friend that you like to be in the same group with? Please write name below. (same grade level only â€“ both parties must make the request to guarantee placement in the same camp group). Please indicate only ONE friend, we will try our best to accommodate.

friend_request

Informed Consent and Acknowledgement

I hereby give my approval for my child's participation in any and all activities prepared by Lassiter Cheer during the camp. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Lassiter Cheer, and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from the camp. In case of injury to said child, I hereby waive all claims against Lassiter Cheer, including all coaches and affiliates, participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including cheerleading.

Signature:

Name

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor's life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to Lassiter Cheer and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child's admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Signature:

Name

I give my permission for my child's likeness to be used in future publication, including the Lassiter Cheer website, flyers, brochures, and other advertisements or promotional materials. yes Yes No No

Signature:

Name

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Lassiter Varsity Competition Squad 2019

Cheer Camp Registration Form