Registration

I would also like to register for: (Camp, Season Etc...)

Student's Full Name(required)

Student's Birthdate MM/DD/YYYY(required)

Student's Grade Entering(required)

Student's Primary Address Including City and Zip Code(required)

Student's Secondary Address if applicable

Student's Cell Phone Number if applicable

Student's E Mail Address if applicable

Student's Health Insurance Carrier(required)

Student's Health Insurance Policy Number(required)

Student's Allergies / Medical Conditions(required)

Parent / Legal Guardian 1 Full Name(required)

Parent / Legal Guardian 1 Phone Number(required)

Parent / Legal Guardian 1 E Mail Address(required)

Parent / Legal Guardian 2 Full Name

Parent / Legal Guardian 2 Phone Number

Parent / Legal Guardian 2 E Mail Address

Emergency Contact Name & Phone Number(required)

AUTHORIZATION AND RELEASE OF LIABILITY I, the parent or legal guardian of the named individual, acknowledge that participation in athletic events involves risk of physical injury. I further acknowledge that persons, who volunteer their time, rather than paid professionals, primarily administer the program of Impact Cheerleading. In consideration for accepting the registration of the named individual and permitting the voluntary participation of the said individuals in this program, I hereby release, discharge and hold harmless Faith Chapel, Impact Cheerleading, its employees, volunteers and other representatives from any claims arising out of or relating to any physical injury that may result to said individual while participating in an Impact Cheerleading sponsored event. Including any physical injury by the negligence of any official or coach while performing his/her duties during practices, outreaches or competitions. I understand that this program is a nonprofit Christian sports ministry program for youth and that my child's participation is voluntary and not essential to completion of requirements of any program, school or government agency. This Release of Liability shall be as broadly construed as allowed by law to include all claims and rights that the child, that as I as a parent/guardian, and that the other family members may have. I am a legally responsible parent or guardian of my child. If any provisions of this Release of Liability are deemed invalid, the remaining provisions shall remain in full force and effect. This Release of Liability shall be binding on me, my family, heirs, next to kin, legal representatives, beneficiaries, successors and assigns. I give permission for free use of my child's name and picture in broadcasts, telecasts or written accounts for any participation in an Impact Cheerleading sponsored event. (required)

MEDICAL CONDITIONS I understand that participation in cheerleading may involve strenuous and prolonged physical activity. I agree that my child is healthy and able to participate in the activities. I understand that Faith Chapel or Impact may request health information concerning my child and/or ask my child to undergo a medical exam. If the church/Impact determines my child unable to participate in the activities of cheer practice or competition, I understand and agree that they might have to make certain decisions out of the concerns and best interests of my child and other participants. (required)

CONSENT TO MEDICAL TREATMENT I, the undersigned, parent or legal guardian of the participant, a minor, hereby authorize the church, staff, coaches or parents of team members acting in the capacity of a supervisor/driver and Impact to arrange for and consent on my behalf to emergency medical and dental care and treatment, including test, and radiology exams and surgery and hospital care and treatment, and to consent to medications for pain and other conditions as prescribed by medical personnel attending my child. I am responsible for payment of any medical charges and expenses not covered by my insurance or the insurance applicable to my child. (required)

PHOTO/VIDEO RELEASE I, parent/guardian of the participant understand that my child's photograph or video may be taken during the course of the 2022-2023 cheer season, which could include practice, competitions or during special events. I hereby grant my permission for the resulting video and/or photographs to be used for any and all publicity and printing purposes. My signature below indicates that all information provided in this form is true and accurate, and that I fully agree to all statements made on the form, including but not limited to the Authorization and Release of Liability, Medical Conditions, Consent to Medical Treatment and Photo/Video Release. (required)

I parent / guardian of the participant acknowledge that I have read and understand the policies outlined in the 2022-2023 FC Panthers Cheer Team Handbook. I have received a copy of all 6 pages and I agree to follow the policies herein. I understand that failure to do so may result in: Cheerleader assigned extra laps or conditioning, Cheerleader sitting out at a practice or performance or Cheerleader removed from the team with no refund of monies paid.(required)

I, parent/ legal guardian of the participant agree to be solely responsible for any cost related to the 2022-2023 cheer season. I understand that any payments made are non refundable.(required)

I, parent/ legal guardian of the participant do hereby understand that if my child is dismissed or chooses to leave the program for any reason, no fees will be refunded, no exceptions. Competition fees, choreography, uniform costs, etc. cannot be refunded. I understand that we are entering a commitment for the entire cheer season. (required)

How did you hear about us?(required)

Social Media Search Engine Signs Friend or Relative

Enter your full name. By entering your full name here you agree to all paragraphs marked above.

Referral's Name

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