Waiver

"*" indicates required fields

Participant Name*

First Last

Program/Team Name*

Address*

Street Address City State ZIP Code

Date of Birth*

Age*

Participant Email*

Phone*

Alternate Phone

Parent/Guardian Name, if under 18 years of age.*

First Last

Email*

Phone*

Emergency Contacts*

Name

Phone

Doctor*

Phone*

Insurance Company*

Policy Number*

Please list any previous injuries, physical conditions or weaknesses that may affect the athlete Condition/Injury*

Medical Authorization and Liability Release*

I authorize Center of Attention Cheer & Dance and its representatives to consent to medical treatment for myself/child when I cannot be reached to consent. I am fully aware that any activity involving motion, height or athletic activities create the possibility of serious injury, paralysis or even death. I further agree to hold Center of Attention Cheer & Dance and its staff harmless for any injury or resulting expense(s). I release and discharge all rights and claims against Center of Attention Cheer & Dance, and its parties. Center of Attention Cheer & Dance strives to provide the maximum in safety procedures and guidelines, and cannot assume responsibility for any accidents, injuries or illness that may occur.

I agree to the Medical Authorization and Liability Release

Participant Consent*

The athlete listed above has permission to participate in Center of Attention Cheer & Dance programs and/or camp. In consideration for the training and coaching provided by Center of Attention Cheer & Dance and its staff, I understand that I must abide by the rules and regulations set forth by the coaches and staff. I understand that violations of any of these rules may result in removal from the classes and or events. We acknowledge and recognize that hazards are present in any athletic event and that injury may result. Center of Attention Cheer & Dance coaches, staff and volunteers will not be liable for injury that occurs during cheer/dance practice, Rising Star Recreational classes, Center of Attention Cheer & Dance camps, or Open Gym.

I agree to the Participant Consent Agreement

Signature*

If participant is under 18 years of age, parent must sign on behalf of the child.