Reign Academy

Team Name: Reign Elite Academy (X by all that apply)

Athlete Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Name

First NameLast Name

Address (if different than Athlete)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Parent/Guardian Home Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact: (Name & Phone Number)

Medical Insurance

Medical Insurance Policy Number

List any medication to which participants are allergic, any previous medical conditions which could impair his/her performance, and any medication currently being taken.

I, the undersigned parent or guardian, do hereby grant permission for my daughter/son, whose name is ____________________, hereinafter shall be referred to as “participant” to participate in All Star cheerleading/competition. In order that the participant may receive the necessary medical treatment in the event of an injury or illness, I hereby hold Reign Elite and its representatives harmless in the exercise of authority.

I further acknowledge and understand and agree that in taking part in this sport All Star Cheerleading there is a possibility of physical illness or injury (minimal, serious, or catastrophic) and that participant is assuming the risk of such risk by participating.

I further agree to hold harmless Reign Elite Academy including its stockholders, owners, directors, officers, competition officials, and staff, the administrators of the competition cheer program and the facility in which practice is being conducted for any injury or illness incurred by participants prior to, during the course of the participants involvement with Reign Elite and after.

Appearance clause:

Permission is granted to use my daughter’s/son’s picture or image in future advertisement and literature for All Day Cheerleading, Inc. and events conducted by them.

I have read and agree to the above release and appearance clause.

Athlete Signature

Parent Signature (if Athlete is under 18 years old)

Reign Elite Academy Medical Waiver and Release Form