Child's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

Parent or Guardian Name *

First Name

Last Name

Second Parent or Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Cell Phone *

(###)

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Mandatory for participation: HAS YOUR CHILD HAD A PHYSICAL WITHIN THE LAST 12 MONTHS? (All Athletes must have had a physical within the last 12 months and routine vaccinations be up to date) *

YES

NO

Date of Birth of Primary Insured *

MM

DD

YYYY

Inherent Risks of Cheerleading Cheerleading is reasonably safe if certain guidelines are followed, but there is the inherent risk of injury as in any athletic activity. Cheerleading is an anaerobic/aerobic activity which includes, but not limited to, jumping, stunting, motions, and tumbling. North Collinwood Thundercats recommends each cheerleader undergo a physical examination by his/her physician before beginning and cheerleading activities. Each cheerleader must inform their coach of all injuries and/or chronic conditions. Although the probability of injury is minimized if you practice correctly, there is always the possibility of one occurring. Injuries that can occur in cheerleading include, but are not limited to, the following: blisters, muscle strains, ligament sprains, joint and muscle soreness, abrasions, contusions, stress fractures, broken bones, spinal cord injuries involving paralysis, and even death. However, if you take certain precautions, the possibility of such injures will be largely decreased. I have read the preceding warning. I thoroughly appreciate and understand the assumption of risks inherent in cheerleading participation. I acknowledge that my child is physically fit and is voluntarily participating in this activity. *

Please insert your (parent or guardian) full name to acknowledge the above statement as electronic signature. Name must match your identification.

First Name

Last Name