Transcript LjC Mini Cheer Clinic

Registration & Medical Release Form
Choose from;
3/11 Quatama Elememntary 6:00-8:00pm, 2/15 Impact
Athletics 10:00am-12:00pm, 3/15 Impact Athletics
10:00am-12:00pm, and 4/12 Impact Athletics 10:00am12:00pm
Each student must have medical coverage to participate. Any previous injuries
must be cleared with coach.
Participant Name_______________________________________ Age____________
Parental signatures below affirm they will keep this policy in effect for the
duration of the student’s participation.
It is to be understood that the Jr. Cheer Board and/or coaching staff is not liable
for any medical, dental or hospital bill occurring as a result of cheerleading
injuries incurred by a student while participating, and such bills, in excess of
insurance benefits shall be the responsibility of the student’s parent(s) or
guardian(s).
I authorize my child(ren) to participate in the cheerleading mini clinic, without a
previous physician physical examination . I believe she/he is physically fit and
able to participate. I realize that this activity involves a potential for injury,
which is inherent in all sports. I further recognize that medical treatment on an
emergency basis may be necessary at a time in which I may not be available to
give my consent in advance. I acknowledge that I have read and understand
this earning.
I have read and understand the medical responsibilities involved with
cheerleading and are willing to abide by them.
Parent/Guardian Signature
Date
Number to call in case of emergency
T-shirt size _______ (Child S -adult xl are available, please specify child or adult)
* T-shirt is included if registered 1 week before clinic date.
•Registration is complete when payment has been made and this Mini
Clinic Parent Release Form has been signed.
•Checks can be sent to: Liberty Jr. Cheer, 21000 NW Quatama rd. #11
Beaverton, OR 97006..
• If you have any questions please feel free to contact Jodi Robinette (503)7202903 or [email protected]
Thank-you and we look forward to working with your cheerleader(s).
Liberty Jr. Cheer Coaching Staff