Kingsway Elite Rec Cheerleading by 94CR64A8

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									                               Kingsway Elite Recreational Cheerleading
                                         Registration Form

                                           Player Information

Last Name________________________________             First Name_________________________________

Street_____________________________ City, State___________________________ Zip Code________

Home Phone__________________________ Date of Birth_______________________

                                           Parent Information

Mother’s name____________________________ Father’s Name________________________________

Parent’s address (if different than child) _____________________________________________________

Parent’s phone # (if different than child) _____________________________________________________

Mother’s cell phone#________________________ Father’s cell phone#____________________________

Mother’s email ____________________________ Father’s email_________________________________

                                Medical/Emergency Contact Information

Doctor’s Name_____________________________ Phone #_____________________

Primary Medical Insurance Company_____________________________ Policy #____________________

Emergency Contact______________________________ Phone #________________________________

Relationship____________________________________


________ I HAVE RECEIVED, READ AND AGREE TO ABIDE BY THE CODE OF CONDUCT.

Waiver and Release of Liability

I agree to hold harmless Kingsway Elite Recreational Cheerleading, its officers, board members, coaches
and sponsors for any claim arising from accidental injury to my child. We assume all the foregoing risks
and accept personal responsibility for damages following such injury, permanent disability, or death. I and
my legal heirs, do hereby discharge, waive and release and covenant not to sue for any and all claims of
damage I may have against the above named individuals and association. The insurance policy of the
Kingsway Elite Recreational Cheerleading will be secondary to any existing insurance. I understand that in
my absence, emergency medical treatment may be administered to my child until such time I can be
contacted. I agree to the terms and conditions of this liability release and give my permission for my child
to participate in this youth activity.

Parent/Guardian Signature_____________________________________ Date_______________________

*Are you interested in coaching or being a coach’s assistant? _________ Contact number______________


Initial payment due per payment schedule: 1 child    $157             check #_______
                                          2 children $255             check #_______
                                          3 children $354             check #_______

**CHEERLEADERS WHO COMPETE FOR ANOTHER RECREATION ORGANIZATION
CANNOT CHEER FOR KINGSWAY ELITE REC CHEERLEADING.

								
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