2018Youth Summer Camp
Waiver
I, ______am allowing my child, ______to participate in the Cheerful Hearts Dance and Cheer Summer Camp. I understand that in any athletic activity, including cheerleading and dance, accidents can happen. In the event my child is injured, I release Cheerful Hearts Dance and Cheer Camp, the camp directors, volunteers and staff, and Walnut Hill United Methodist Church from any and all liability. I understand that my child will be taught in safe progressions, however there is always a risk involved with this type of activity.
Check Camp Sessions your child will attend:
______Session 1: June 11 – June 14
9 AM - Noon
$150.00/ Registrant
______Session 2: June 25 – July 28
9 AM - Noon
$150.00/ Registrant
______Session 3: July 9 – July 12
9 AM - Noon
$150.00/ Registrant
______Session 4:July 16–July 19
9am - Noon
$150.00/Registrant
Parent/Guardian Printed Name: ______
Parent/Guardian Signature: ______
Date: ______
2016 Youth Summer Camp
Parental Permission
I grant permission to the camp director, assistants or assigned chaperones of the camp to act on my behalf for (child’s name) ______in granting permission for evaluation/treatment of medical problems including injury. I understand that participation in cheerleading and dance camps involve motion and rotation in a unique environment and as such carries with it the risk of injury or even death. All campers must be covered by their own medical insurance. All medical expenses incurred will be the responsibility of the camper and/or the camper’s family. I understand that should a major medical problem arise, an attempt will be made to notify me by telephone. I hereby release the Cheerful Hearts Dance and Cheer Camp Directors, cheerleaders, volunteers and Walnut Hill United Methodist Church and all its employees from all claims on account of any injuries, which may be sustained by my child while attending Dance and Cheer Camp. I also agree to indemnify this Dance and Cheer Camp, Directors and Staffand Walnut Hill United Methodist Church and its employees from any claim, which may hereafter be presented to my minor camper for publicity, advertising, or other commercial purpose. This camp admits all applicants without regard to disability, race, color, religion, national or ethnic origin, or sexual orientation.
List of all allergies/reactions:
______
Past Illnesses, Injuries, and special needs:
______
Emergency Contacts:
______
______
I HEREBY CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THISAUTHORIZATION.
Parent/Guardian Printed Name: ______
Parent/Guardian Signature: ______
Date: ______