CHAOS Extreme Cheer Registration Form 2025-26

Emergency Contact Information
Name of Emergency Contact

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relation to Athlete
Confirmation

I hereby declare that I give my full express consent to let my child be given immediate treatment by any qualified medical personnel in circumstances which may need immediate attendance and care.
Clinic / Hospital
Name of Family Doctor

First NameLast Name

Medical Information
I hereby grant permission to allow my child to participate in activities (i.e. cheerleading, dance) as sponsored by the CHAOS Extreme Cheer Program.

Furthermore, I hereby release CHAOS Extreme Cheer and it’s owners, agents, and coaches from any legal or financial responsibility resulting from actions of, or injury to my child while engaged in any or all of these sponsored activities (i.e. practices, competitions). It is my understanding that every registered participant will be covered by accident insurance.

I also certify that my child has NO HEALTH OR PHYSICAL IMPAIRMENTS which will hamper his/her ability to perform as a Athlete or cause his/her participation to be unsafe to themselves or other participants. If there are any health/physical problems KAOS Bulldogs Cheer should know will be indicated below:
Any Allergies to Medicine and Antibiotics?
Health/Physical Limitations (if any):
Insurance Carrier:
Policy#:
I/We agree with the above *

YesNo

CHAOS Extreme Cheer 2025-26 Registration Form