Powder Springs ES Cheer Club Enrollment
Fall 2022, Mondays, 2:30-3:30
21-22 School/Grade Level
Date of Birth
Street Address Line 2
State / Province
Postal / Zip Code
T Shirt Size
Student Photo (Optional)
The parents/guardian listed below will be the authorized person to pick-up the child after the class.
The parents/guardian listed below will also be the primary emergency contact person.
People permitted to pick up your child from Cheer Club
Does the child have any allergies? If yes, please list them below:
Does the child have any previous injuries? If yes, please explain them below:
Does the child have any current medical conditions? If yes, please list them below:
Does the child takes any medication? If yes, please list them below and explain its purpose:
I, the parent/guardian of this camper gives authority to the staff of this camp to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorized first aid, medical/surgical diagnosis, and treatment which may deem necessary.
I released the organizers, coaches, staff, or managers of this camp for any responsibility in case of accident, illness, or injury during my child's enrollment.
Payments are inelgible for refunds however if your student is unable to participate for any reason including but not limited to; injury, school closings, sickness, scheduling issues, etc a class credit will be given out that can be used anytime within 1 calendar year.
I confirm that all information given in this form is true, complete, and accurate.
( X )
Fall 2022 Registration
Includes T-Shirt and Performance Fee
Should be Empty: