Chocowinity Middle School Athletic Booster Club

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Cheer Clinic October 22, 2016

PARTICIPANT INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Participant:

WAIVER INFORMATION

*** I, the undersigned parent/guardian, do hereby give permission for my daughter/son to attend and to participate in the cheer clinic sponsored by the Chocowinity Middle School Cheerleaders. I further understand that in participation in this event there is a possibility of physical injury. I release all claims against Chocowinity Middle School for any injuries which my daughter/son may sustain or suffer while attending or participating in the event.

I/we agree with the above *

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Cheer Clinic October 22, 2016