Penncrest Cheerleading - (Media, PA) - powered by LeagueLineup.com

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YOUTH CHEER CLINIC REGISTRATION

PARTICIPANT INFORMATION

* First Name:

* Last Name:

* Street Address:

* City:

* State:

* Zip Code:

* Birthdate:

* Age:

* Gender:

* Grade:

PARENT/GUARDIAN

Allergies:

Medications:

* First Name:

* Last Name:

* E-Mail Address:

* Cell Phone Number:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact Name:

* Phone Number:

* Relationship to Participant:

WAIVER INFORMATION

I release the Penncrest Cheerleading coaches, cheerleaders, and the Rose Tree Media School District from any and all liability arising or connected to injury that the minor may incur at the clinic or while cheering at the game. I authorize Penncrest Cheerleading to procure any medical care required.

I/we agree with the above *

* indicates required fields