KC CHEER TRYOUT REGISTRATION

2009 – 2010 Season

 

NAME                                                          Age:          Grade ’10                  

 

BIRTH DATE:                                                                                                            

   

ADDRESS___________________________________________________

                           STREET                                                    CITY                                         ZIP

 

PHONE_____________________________________________________

                                   HOME                                                                                       CELL

 

PARENTS NAME____________________________________________

 

PARENTS EMAIL_____________________________________________

 

IN CASE OF EMERGENCY CONTACT________________@__________

                                                                                                OR

 

            Tryout fee $45.00_________check number _________cash________

                                                            MAKE CHECKS TO: KC CHEER

PLEASE MAKE A COPY OF INSURANCE CARD OR FILL OUT THE

BELOW INFORMATION SO THAT KC CHEER HAS THIS ON FILE:

 

INSURANCE PROVIDER ___________________________________________________________

 

POLICY NUMBER _________________________________________________________________

 

HOLDERS NAME _________________________________________________________________

 

DR.’S NAME ON BACK OF CARD OR PHONE NUMBER _______________________________

MEDICAL FACILITY TO BE USED IN CASE OF EMERGENCY:

_________________________________________________________________________________

 

 

Amateur Minor Athletic Waiver And Release of Liability. The participant acknowledges and fully understands that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inaction’s or negligence of other, the rules of participation, or the condition of the premises or any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time. Assume all the forgoing risks and accepts personal responsibility for the damages following such injury, permanent total disability or death Releases, waives, discharges and covenants not to sue KC Cheer its affiliated clubs, their respective administrators, directors, agents, coaches, and other employees of the organization; the participants, sponsoring agencies, sponsors advertisers; and if applicable, owners and lessors of the premises used to conduct the event, all of which are hereinafter referred to as “releases” from any and all liability to each of the undersigned, her of his heirs and next of kin for any and all claims, demands, losses or damages on the accounts of injury, including death and damage to property, caused or alleged to be caused in whole or in part by the negligence of the releases or otherwise. I understand I have given up substantial rights by signing, and sign voluntarily.

 

 

 

_______________________________              _______________________________

Parent/Guardian                          Date             Participant                   Date