Aspire Competitive Cheer & Dance

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2016-2017 Aspire Competitive Cheer & Dance Registration Form

PLAYER 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:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

I understand that my child can be injured while participating in Aspire. In addition to giving my full consent for my child to participate, I do hereby waive, release, and hold harmless ASPIRE CHEER & DANCE, its officers, coaches, sponsors, supervisors, volunteers, and representatives for any injury that may be suffered during participation.

I/we agree with the above *

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Signature:

Date:

Signature:

Date:

* indicates required fields

IMPORTANT: Online Payment with credit cards is not active for this form

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2016-2017 Aspire Competitive Cheer & Dance Registration Form