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Alabama Cheerleading Center, LLC. Registration Form
I acknowledge, by my signature, that the information which I am giving is current and that I have read and agree to the conditions and rules of Alabama Cheerleading Center, LLC.
Participant_____________________________ Home Telephone _________________
Date of Birth______/______/______ Age________ Male_______ Female_______
Address________________________________________________________________
City___________________________ State __________ Zip Code_________________
Mother’s Name _______________________ Cell Telephone ___________________
Father’s Name ________________________ Cell Telephone ___________________
Emergency Contact _________________________ Telephone ___________________
E-mail Address__________________________________________________________
Please list any medications your child is currently taking, any allergies the child
may have or other noteworthy medical information:
______________________________________________________________________________
______________________________________________________________________________
The following individuals have my authorization to transport my child from the
Alabama Cheerleading Center, LLC., that the individuals named below are
the only persons to whom my child may be released:
Name: Relation:
_____________________________ _________________________________
_____________________________ _________________________________
_____________________________ _________________________________
Emergency Authorization
I understand that gymnastics and cheerleading are sports and that, as in all sports, there exists the potential for injury, minimal to catastrophic. Therefore, I authorize the Alabama Cheerleading Center, LLC. staff to take whatever emergency medical measures are deemed necessary for the protection of my child while in their care including calling
EMS for transportation to a hospital or clinic.
Insurance Company: _________________ Insurance Group Number: __________________
Insurance Contract Number:____________________
Video and Photography Release
I understand that my child’s photograph/video may be taken during the course of class instruction or during a special event. I hereby grant ____ / do not grant ____ my permission for the
resulting video / photograph to be used for any / all publicity and printing purposes.
Signature: ______________________________________ Date: _____ / _____ / _____
Registration Fee Date: _________ ‘Bama All-Stars / ACC West / ACC East (Circle One)
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