2024 Cobb PAL Cheerleading Camp
Participating Child's Name
*
First Name
Last Name
Birth Date:
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Year
Age
*
Gender
*
Male
Female
Please select one answer
*
Asian or Pacific Islander
Black or African American
Hispanic or Latino
White or Caucasian
A race/ethnicity not listed here
What is the name of your child's school?
*
Participating Child 2 Name:
First Name
Last Name
Child 2 Birth Date
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January
February
March
April
May
June
July
August
September
October
November
December
Month
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1
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31
Day
Please select a year
2024
2023
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2020
2019
2018
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2015
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2013
2012
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1930
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1928
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1925
1924
1923
1922
1921
1920
Year
Age
Gender
Male
Female
Please select one answer
Asian or Pacific Islander
Black or African American
Hispanic or Latino
White or Caucasian
A race/ethnicity not listed here
What is the name of your child's school?
Child 3 Name:
First Name
Last Name
Participating Child 3 Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Age
Gender
Male
Female
Please select one answer
Asian or Pacific Islander
Black or African American
Hispanic or Latino
White or Caucasian
A race/ethnicity not listed here
What is the name of your child's school?
Parent/Guardian
*
First Name
Last Name
Cell Phone Number:
*
-
Area Code
Phone Number
Alternative Phone Number if Applicable
-
Area Code
Phone Number
E-mail
*
Address:
*
Street Address
Street Address Line 2
City
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Participant Agreement
Parental Consent, Photo/Media Release
*
I, the parent and or/legal guardian of the above named son/daughter hereby grant permission for his/her participation in the activities of Cobb PAL and their related activities. On Behalf of my son/daughter and myself, I acknowledge that he/she will be using facilities at his/her own risk and I, on my own behalf, hereby release, discharge and indemnify Cobb PAL from all liability for injury to person of damage to entrant. You are authorized on my behalf and at my account to take measures and arrange such medical and/or hospital treatment, as you may deem advisable for the well being of my son/daughter.
I understand that Cobb PAL will take & use action/still photos and video of my child participating in regular scheduled PAL practices/events. Images will be used for official club purposes such as: website, internet, social network sites, brochures, flyers, newsletters, marketing materials, media & press releases. Furthermore I understand, I consent to the organizations right to publish such images and video for announcements, marketing & advertising.
I have read, understood, and accepted the participant agreement.
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