CHEER TIME ALL STAR CHEER
To register, please complete and return this form along with registration fee to
CHEER TIME, 5800 COMMERCE CT. SHERWOOD, AR 72120
REGISTRATION FORM
Child’s Name ______Age____ Sex____ Birth Date ______
Parent’s Names ______
Address______City______Zip Code ______
Home Phone # ______Mom Mobile# ______
Parent’s email ______Mom Work # ______
DadMobile # ______Dad Work # ______
Mom’s Employer ______Dad’s Employer______
Emergency Name ______Emergency # ______
School ______Grade ______
Medical Insurance Name ______Policy # ______
Doctor Name ______Phone # ______
How did you hear about our program? ______
(If from a friend, please name.)
Are there any physical or emotional limitations the instructors should consider in working with your child? ______
The non refundable $25 registration fee per child must be paid prior to your child’s first lesson.
Cheer Waiver and Release Form
I fully understand that CHEER TIME staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release the CHEER TIME staff to render temporary first aid to my child in the event of an injury or illness, and, if deemed necessary by the CHEER TIME staff to call our doctor and to seek medical help, including transportation by a CHEER TIME staff member and/or its representatives, whether paid or volunteer, to any health care facility or hospital or the calling for an ambulance for said child should the CHEER TIME staff deem this to be necessary. INITIAL: ______
Parents should make their children aware of the possibility of injury and encourage their children to follow all the safety rules and coaches’ instructions. CHEER TIME, it coaches and other staff members, will not accept responsibility for injuries sustained by any student during the course of cheer or tumbling instruction, or open workouts, or in the course of any party exhibition, competition or clinic in which he or she may participate or while traveling to and from the event. With the above in mind, and being fully aware of the risks and possibilities of injuries, I consent to have my child participate in the programs offered by CHEER TIME. I, my executors or other representatives, waive and release all rights and claims for damages that I or my child may have against CHEER TIME and-or its representatives,whether paid or volunteer. I now also affirm that I now have and will continue to provide proper hospitalization, health and accident insurance coverage which I consider adequate for both my child’s protection and my own protection. I also understand that CHEER TIME is in no way responsible for any child(s) injuries that are sustained in or around the vicinity of the CHEER TIME establishment (i.e. siblings, cousins, friends etc.). INITIAL: ______
I understand that I am responsible to pay fees for all classes I am signed up to participate in. CHEER TIME does not prorate for classes missed on student’sbehalf. Payments should be made by the 1st of every month to avoid a $25.00 late fee after the 10th of every month. I also understand that should I decide to remove my child from the program, I must provide a written notice to CHEER TIME 30 days in advance.
PARENT/GUARDIAN SIGNATURE:______DATE:______