AUGUST 25th CHEER CAMP REGISTRATION by 04t6jy

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									    AUGUST 25th CHEER CAMP REGISTRATION
                                        Top Star Training Center
                                         1708 W. Hensley Rd
                                         Champaign, IL 61822
                                             217-378-5058

Child’s Name__________________________________________

Child’s Date of Birth______________

Address____________________________________________________

City_____________________ State_______ Zip Code_________

Mother’s Name_________________________________________ Cell Phone #_______________

Father’s Name__________________________________________ Cell Phone #_______________

Emergency Contact if Parent is Unavailable_____________________________________________

Phone # for Emergency Contact ____________________________

Doctors Name_____________________________________ Doctors Phone #__________________

Health Insurance Provider and Policy #_________________________________________________

RELEASE: I hereby consent to have my children participate in activities on Top Star Training Center
premises. I realize there are risks involved in respect to all sports, including cheerleading, tumbling
and trampoline, and that there is a chance of serious injury regardless of safety measures used. This
includes catastrophic injuries. Every effort is made on a continual basis to provide a safe, accident free
environment. Basic first aid will be administered to all minor injuries. Upon a medical emergency,
911 will be called and parents/guardians will be contacted. I hereby waive and release all rights and
claims that I may have at anytime against Top Star Training Center or any of its representatives for any
injury or damage claims in connection with Top Star Training Center programs and/or other related
activities.


Parent Signature___________________________________________________

Date Signed__________________________

Check #_____________

								
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