Participant's Information:

Your Email

Birth Date

Home Phone

T-Shirt Size

Child's Name

Child's Age as of Aug. 31, 2010

Address

City

Guardian's Information:

Mother/Guardian's Phone #

Father's Phone #

Emergency Contact's Phone #

Mother/Guardian's Name

Father's Name

Emergency Contact other than Parents

Relationship

Medical Information:

Any Medications

Health Concerns

Class Information:

Class Description/Day of Class

Fee Amount

Code #

WE NEED CLASS CODE/DAY IN ORDER TO EXCEPT YOUR SUBMISSION. All classes are first come first serve so if you decided to come the day of there is a possibility all spots will be filled.

Open Gym/Class Waiver:

For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledge, as parent or legal guardian of a minor (hereinafter .Minor.), hereby grant the permission necessary to allow Minor to participate in Ignite Cheerleading, Inc.and or any activity affiliated with Ignite Cheerleading which include but not limited to cheer classes, birthday parties, stunting classes, parades, outside events, open gym, ect. I, in my own behalf and on behalf of the Minor, further agree to release and to hold harmless Ignite Cheerleading, Inc., the Hosting site, on whose premises the practice, competition or any other activity will occur, the affiliates of Ignite Cheerleading, Inc. And the Location and respective instructors, sponsoring organization, facility, employees of Ignite Cheerleading, Inc. or any other party involved from any and all liability for negligence or any other claim judgment, loss, liability, cost and expenses (including, without limitations, attorney fees and costs) arising out of or connected with the practice or competition, including any claim arising out of or connected with any illness or injury (minimal, serious, catastrophic and/or death) that the Minor may incur or sustain during the clinic/practice/competition, all activities associated with Ignite Cheerleading, Inc. I further agree to reimburse and make good to releases any loss, or costs releases may have to pay as a result of any such action, claim, or demand. I, in my own behalf and on behalf of the Minor, hereby warrant that I have read this Liability Release in its entirety and fully understand its contents. I, in my own behalf and on behalf of the Minor, am aware that this Liability Release releases Ignite Cheerleading, Inc. from liability and contains an acknowledgment of my voluntary and knowing assumption of the risk of injury or illness. I, in my own behalf and on behalf of the minor, further acknowledge that nothing in this Liability Release constitutes a guarantee that the clinic/practice/competition will occur. I, in my own behalf and on behalf of the Minor, have signed this document voluntarily and of my own free will. Every parent/guardian needs to sign a new waiver every September.

I understand and accept the above information

Signature (Please type your name)

After submission please pay class fee below.