CHEER TIME REVOLUTION ALL STAR CHEER

To register, please complete and return this form along with registration fee to CHEER TIME - 9107 Warden Road - SHERWOOD, AR 72120 501-835-6255

Name

First NameLast Name

Age

Sex

Birth Date

Date

Parents Names

Address

Street Address Line 2

City

Mom Cell

Parents Email

example@example.com

Dad Cell

Moms Employer

Dads Employer

Emergency Name

School

Grade

Medical Insurance Name

Policy

Doctor Name

Phone

How did you hear about our program

Are there any physical or emotional limitations the instructors should consider in working with your child

The non-refundable $30 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. 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, its 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 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's behalf. Payments should be made by the 1st of every month to avoid a $30 late fee after the 10th of every month. If legal action is necessary I will be also be responsible for all collection fees. 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. INITIAL:

DATE

Date

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 students behalf Payments should be made by the 1st of every month to avoid a 2500 late fee after the 10th of every month If legal action is necessary I will be also be responsible for all collection fees 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 INITIAL