Classy Divas Stomp & Shake Cheer Registration Form

Classy Divas Stomp & Shake Cheer Registration Form

Classy Divas Stomp & Shake Cheer Registration Form
Date: January 26, 2025
Time: Grades 6-8 2pm - 4pm, Grades 9-12 5pm-7pm
Location: 1046 Westside Dr., Greensboro, NC 27405
Participant Information
Participant's Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
School Name
Grade/Level
Medical Information
Please let us know if you have any allergies, existing illnesses or any medical conditions.
Are you currently taking any medication? If yes, please provide the generic name and its purpose?

Parent/Guardian Details
Parent/Guardian Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Details

If parent/guardian cannot be reached.
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number

Payment Details

Payment Details

Tryout Fee$10.00

Enter description

Total $0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Acknowledgment, Authorization, and Waiver
My child has my authorization to engage in the activities of the M& T Performing Arts' Classy Divas cheer program.

I allow taking photography of this participant that can be used for M&T's portfolio or advertising.

I authorized M&T Performing Arts to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if they are unable to contact the parent/guardian. I allow them to apply first aid, medical or surgical diagnosis and treatment as necessary.

I allow M&T Performing Arts to provide or administer the medication or supervise in self-administration.

I release M& T and any of its coaches, staff, and manager for any responsibility in case of accident, illness, or injury during this participant's enrollment.
Date Signed

MonthDayYear
Date
Parent/Guardian Signature

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