SWISS TURNERS
CHEER TEAM
REGISTRATION FORM
Team: ________________________________________
Date: _________________Monthly
Tuition:____________
Student’s Name:___________________________________________Birthday:
______________ Grade:_________ Address:______________________________________________City:______________________Zip:___________
Home Phone :_______________________Cell
Phone:____________________ Email:________________________
Emergency Contact and Phone Number
:__________________________________________
Mother’s
Name: ________________________ Work Number:_____________________
Father’s
Name: _________________________ Work Number: ____________________
Any Medical
Problems?___________________________________________________________
Physician’s Name:
___________________________________ Phone: _____________________
Insurance Carrier :
___________________________________ Phone: _____________________
Policy/Group Number
____________________________________________________________
· I
do hereby grant permission to emergency and/or hospital staff members to
administer immediate treatment to my child if she should be injured or sick.
NO prior
determination of life-threatening emergency or danger of serious or permanent
injury resulting from delay of treatment need be made under this authorization.
I fully understand that any and all expenses resulting from treatment are
my responsibility.
· I
further hold that my child is in good health and physically capable of
participation in all of Swiss Turners Cheer Team activities.
· I
am fully aware that any activity involving motion or height creates the
possibility of serious injury, including catastrophic injury or death.
· I
also agree to hold harmless Swiss Turners Cheer Team/ Gymnastics Academy, its
staff, and any event facility for any injury as a result of my child’s
participation in Swiss Turners Cheer Team activities.
Parent/Guardian Signature:
______________________________________________Date:
________________