One Village Cheerleading League

One Village Volleyball League

August 18 - October 27

For more information, contact:

Joslyn Benson, Executive Director – One Village of New Miami

Email: info@onevillageofnewmiami.org or Phone: (513) 600-2652

Athletes Information

Athletes Name*

First NameLast Name

Age*

Date of Birth*

Date

Gender*

MaleFemale

Guardian / Parents Names*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Cell Phone*

Area CodePhone Number

Home Phone

Area CodePhone Number

E-mail*

Acknowledgment, Authorization, and Waiver

I hereby approve my child's participation in all volleyball camp activities prepared by One Village of New Miami and waive all claims for damages arising from such participation. This release discharges One Village of New Miami, its officials, officers, volunteers, staff, and agents from liability for injuries to said child arising out of traveling to, participating in, or returning from selected cheerleading sessions.*

AgreeDisagree

Medical Release and Authorization

I hereby authorize the diagnosis and treatment of my child by a qualified and licensed medical professional in the event of a medical emergency that requires immediate attention, in the opinion of the attending medical professional. This authorization is granted only after a reasonable effort has been made to contact me.*

AgreeDisagree

Photography and Video Release

On behalf of my child, I grant permission for pictures and/or videos of my child to be taken for the sole purpose of literature, advertisements, and events for One Village of New Miami.*

AgreeDisagree

By signing below, I provide an electronic signature that ing and has the same effect as an original manual signature.

Date

Parent/Guardian Signature*

For more information, contact Executive Director Joslyn Benson at sports@onevillageofnewmiami.org or 513-600-2652.