Cheer Clinic Registration Form

Hollywood PAL Cheer Camp Registration Form
Date: April 19, 2025
Time: 9:00 AM - 1:00 PM
Location: Hollywood PAL
2311 N. 23rd Ave, Hollywood, FL 33020
Cheerleader Information
Camper Name*

First NameLast Name
Age Group*
Date of Birth*

MonthDayYear
Date
Gender*
Email
example@example.com
Camper Shirt Size*
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
Would you like to join Hollywood PAL General WhatsApp Group Chat?

YesNo
Emergency Contact Details

If parent/guardian cannot be reached.
Contact Name*

First NameLast Name
Phone Number*

Area CodePhone Number

Acknowledgment, Authorization, and Waiver
This camper has my authorization to engage in the activities of the Hollywood Police Athletic League. I allow taking photography of this camper that can be used for Hollywood Police Athletic League for advertising.

I authorized Hollywood Police Athletic League 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 Hollywood Police Athletic League to provide or administer the medication or supervise in self-administration.

I release Hollywood Police Athletic League and any of its coaches, staff, and manager for any responsibility in case of accident, illness, or injury during this camper's enrollment.
Date Signed*

MonthDayYear
Date
Parent/Guardian Signature*

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