King’s Cheer Fall Clinic
Registration Form
January 27, 2017
When: 12:30-2:30pm
Where: Schirmer Auditorium
Cost: $55 includes the two hour clinic with all the High School Cheerleaders, T-shirt, and cheering at the Girls Varsity Game the
SAME NIGHT – January 27
Proceeds from this clinic will go towards supporting the cheer program and to our Spring Break Mission trip to put on a similar clinic for a low income school.
Childs Name______Age______
Parent’s Name______
Address______
Contact Phone #s______
Email______Tshirt size Youth S M L Adult S M L
Emergency Contact______
Number______
Person Authorized to pick up______
Physician’s Name/Number______
Allergies______
Medical Restrictions______
Please drop off at the elementary school this registration, the release form, and a check made to King’s Schools for $55. If you have any questions please e-mail Joey Wasson at
WAIVER, RELEASE, ASSUMPTION OF RISKS & INDEMNIFICATION: I, the parent or legal guardian of ______(“Camper”), agree as follows: I acknowledge and understand that certain activities, including but not limited to, use of playground equipment, field trips and other KKC activities, can be hazardous and may result in injury, including loss of life. I voluntarily assume any and all risks of loss, damage or injury while Camper is on the premises.
In consideration for Camper’s participation, I represent that I am the parent or legal guardian and hereby release and forever discharge CRISTA Ministries, King’s Schools, King’s Kids Club and their servants, employees, officers, directors, trustees and all other persons or entities acting on their behalf (collectively referred to as “CRISTA”), from any and all claims, actions, damages, liabilities, costs or expenses and attorney fees which are related to, arise out of, or are in any way connected Camper’s viewing or participation in any activities. By signing this Agreement, it is my intention to waive any rights I may otherwise have to sue or seek damages from CRISTA; except where injury, death or disability results from CRISTA’s gross negligence.
I further agree to indemnify, hold harmless and defend CRISTA against any and all claims for damages, costs, expenses or attorney’s fees brought by any third party in connection with or arising out of Camper’s involvement or participation. Moreover, in consideration for Camper’s participation in activities, including the use of equipment and facilities, I further agree to indemnify and hold CRISTA harmless from any and all claims which are brought by, or on behalf of Camper and which are in any way connected with such use or participation by Camper. This Agreement shall be effective and binding upon my marital community, estate, heirs, agents, personal representatives and assigns.
EMERGENCY CONSENT: ______(Camper’s name) may receive emergency or routine medical care from a licensed physician or emergency facility if I cannot be reached in an emergency situation. Such emergency or routine care includes emergency surgery, administration of medications or other measures as determined necessary by a licensed physician. I agree to assume the responsibility for all medical, transportation and rescue-related expenses incurred on behalf of Camper.
PHOTO RELEASE: CRISTA may publish photos taken of Camper and I release all rights to remuneration for such photos.
Yes____ No_____
I hereby certify that I am over 18 years of age; I have carefully read the foregoing and acknowledge that I understand and agree to all the terms and conditions. I have had the opportunity to ask any and all questions regarding this Agreement and the effect of the same. I am aware that by signing this Agreement, I assume all risks, agree to indemnify CRISTA and waive and release certain rights that I may otherwise have. Handwritten changes to the language of this document are not permitted and will not be honored. This Agreement constitutes the entire Agreement and shall not be modified except via written document, executed by both parties.
Parent/Legal Guardian Signature (on behalf of the marital community)
Parent/Legal Guardian printed name
Date