Grade (09-10):__________________ Age:________________________________
City:_________________ Zip:______________Home Phone:________________
Mother’s Name:_________________________ Cell Phone: ________________
Mother’s Work #____________________ Father’s Work #_______________
Father’s Name:________________________ Cell Phone:__________________
Physician’s Name:__________________________ Phone:________________
Insurance Company___________________________ Policy #______________
Medical Conditions/ Allergies/Impt. Info_____________________________
Email Address (Print Clearly)_____________________________________
In Case of ANY Emergency I Authorize Mississippi Cheerleading Academy to Seek Medical
Attention For My Child.
Signature of Parent/Legal Guardian Date
All participants must pay by:
Automatic payment from Checking/Savings Acct.
Assumption of Risk,
Liability & Media Release Form
In consideration of being allowed to participate in any way in the Mississippi Cheerleading Academy program, its
related event and activities, the undersigned, being parent, legal next of kin, or legal guardian of
___________________ (___/___/___) ( ), acknowledge, appreciate, and agree that:
Participant’s Name Birthday Age
1. The risk of injury from the activities involved in this program is significant, including the potential for
permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk,
the risk of serious injury does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM
THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my participation; and
3. I willingly agree to comply with the stated and customary terms and conditions for participation and bring such
to the attention of the Academy immediately; and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE,
INDEMINIFY, AND HOLD HARMLESS the Mississippi Cheerleading Academy, their officers, officials, agents
and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and
leasors of premises used for the activity (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY,
DISABILITY, DEATH, and loss or damage to person or property associated with my presence or participation,
WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent
permitted by law.
5. I also affirm that I now have and will continue to provide proper hospitalization, health, and accident insurance
coverage, which I consider adequate for both my child’s protection and my own protection.
6. I completely understand that photographs/video may be taken of my son/daughter during the course of this
activity or event, and that such photos may be used at a later date for promotional purposes.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIONAL RIGHTS BY
SIGNING IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
X_______________________________Age______ Date Signed______________________
Participant’s signature (for those 18 years of age and above)
For Parents/Guardians of Participants of Minority Age
(Under age 18 at time of registration)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to
his/her release as provided above all the Releasees, and, for myself, my child and our heirs, assigns, and next of
kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my
minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE
NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.
X_____________________ _________________________ Date signed__________________
Parent/guardian’s signature (print name)
Street Address/City, State,& Zip Code Home Phone (including area code)
Emergency Contact (cell phone) Email Address
Mississippi Cheerleading Academy
Fees and Tuition
Competitive Cheerleading, while not as costly as some youth activities, can still be an expensive sport. Entry Fees
for competitions alone are hundreds of dollars a year per athlete. Before you consider this or any program, please
carefully consider the financial commitment involved.
There are a number of costs associated with competitive cheerleading. We, at Mississippi Cheerleading Academy,
want to do our best to make it as affordable as possible. We hope to have plenty of fund-raisers and events that
will help with the cost during the year, but we want you to know up-front before you make a commitment to our
* Registration Fee $25.00 (Try-out Fee) *Monthly Tuition fees
*Competition Fees (Set as Monthly fees) * Practice Wear
* Uniform and Accessory Fees * Mandatory Cheerleading Camp
A registration fee is required as we collect your child’s registration form.
The registration fee is $25.00.
Monthly tuition includes all team practices.
Tuition will be drafted on the 5th of each month for all participants.
All Star Squads: $100- includes 2 All-Star practices and 1 free, mandatory tumbling Class
Tumbling Classes: $50 a month- This includes a one hour class once a week.
Automatic Monthly Payment Policy
Monthly tuition is drafted by the 5th of the month.
Automatic Draft Payment (ALL Participants)
1. Tuition will be drawn automatically from your checking/savings account.
2. There will be no service charge for this option
3. If your automatic checking/savings returns NSF or Invalid, MCA will automatically use the
credit card on file and add a $25 service fee.
Failure to pay monthly tuition will result in the athlete sitting out of practices until their
account becomes up-to-date.
Family Discount Policy
The oldest child pay’s full tuition; each additional child receives a $10 per month discount
for All-Star participants and a $5 per month for tumblers.
There will be no refunds or partial monthly credits if you choose to join in mid-month, if you
choose to not continue to participate in our program, or if your child is removed from a squad.
There will be no credits given for short months (Winter Break, Spring Break, competitions, etc..)
There will be NO refunds on Competition Fees! Tumbling tuition will be drafted the entire three
If you pay up-front for the entire year, we will not refund your money for any reason if your child
decides to withdraw from the program. (NO REFUNDS on YEARLY TUITION)
Mississippi Cheerleading Academy
Rules and Regulations
Here at MCA we will strive not only to be the best in cheerleading but will also strive to teach
each athlete morals, values and life lessons.
Gym Rules and Regulations
If you have a problem with anything, please do not hesitate to contact the gym, your coach, or the
owners at the appropriate times.
Gossiping about other team members and/or other teams is strictly prohibited.
No profanity or abusive language. If an athlete uses inappropriate language toward a coach, he/she
will be dismissed from the cheerleading program immediately.
If you have any opinions or comments please feel free to use the comment box. Ultimately all
decisions will be left up to the coaches’ discretion.
The dismissal or addition of any athlete at any time is the coach’s discretion.
Practices may be changed or added at any time throughout the season.
Athletes that leave the team will NOT be subject to any refunds. They will only be charged fees
required of the gym as a result of their absence. Athletes who wish to leave the squad during
competition season will be fine- $50.
It is the parent’s responsibility to know what is going on with your squad at all times. This includes but
is not limited to payments, practice times, practice uniform, competition fees, and competitions.
Non-participation regarding practices and competitions ARE NOT to be used as punishment for your for
your child’s actions outside of the gym. You not only punish your child but every other child and parent
on that team.
We will do our best to work with any other extra curricular activity that you may have. However, if your
extra curricular coach refuses to work with our mandatory practices and competitions, you will have
to choose which activity you will continue.
Each athlete must have a chaperone at every competition. It is not your coach’s responsibility to be
your child’s chaperone.
All MCA Athletes and family members will show good sportsmanship at all times.
Parents and/or athletes should not approach a coach or staff member during competitions to discuss
or complain about the teams’ performance. We recommend that you set-up a meeting with a coach
after competition to discuss your concerns.
Parent Information and Guidelines
0nly athletes and coaches allowed in the practice area.
No one is allowed to yell onto the floor or to speak to any team member or coach while practice is in
Please, do not gossip about other athletes and/or parents on any team throughout the program. Please
do not gossip about any one on our staff.
The coaches reserve the right to close practice at any time.
Please feel free to speak to your coach about anything—just remember to do it at the appropriate
place and time.
Parents need to note that cheerleading is a highly competitive and dangerous sport. The stunts and
tumbling could lead to injuries. This includes but is mot limited to bruises, pulled and strained
muscles, torn and strained ligaments, broken bones and dislocations.
We, at MCA, will take every precaution to limit these injuries from happening. Unfortunately, we
cannot prevent them all. In the event that your child is injured in practice, please have them speak
immediately with a coach, and we will take every necessary step to ensure your child’s well being and
Every athlete will be given water and breaks during practice. If your child chooses to bring his/her
own water bottle for practice, make sure you remember to bring it inside the gym when practice
Practice Rules and Guidelines
All practices are mandatory
All absences, excused or unexcused, can potentially alter the athlete’s role on the team.
Please note that full attendance is important and excessive tardiness will not be tolerated. Team
members arrive late or have to leave early may disrupt and distract practice.
Absences are NOT allowed the entire week prior to a competition.
During competition season, MCA reserves the right to schedule extra practices if necessary.
There is no cost to the athlete.
Proper practice wear may be required and will be communicated to each individual team. This is
done for consistency and to alleviate distraction.
Hair must be pulled back, away from the face, for safety reasons.
Gum chewing, food and soft drinks are not allowed inside gym area. There will be consequences if
athletes are caught violating this rule.
INSUBORDINATION IS UNACCEPTABLE! The following actions can result in gym community
service, suspension, and possible removal from MCA:
o Temper tantrums, outbursts, and other signs of poor attitude
o Profanity, lewd language
o Showing disrespect to the coaches by talking back, eye rolling, etc.
o Showing disrespect to a fellow team member
o Unnecessary and excessive talking
o Use of cell phones for non-emergency calls during practice
Parents must sign and return an All-Star commitment form before the month of June to continue
in the program. The form will be given to you at the First Parent Meeting in May.
Family Vacation dates need to be given to a coach 2 weeks prior to the dates your child will miss
Competition Rules and Guidelines
All competitions are required. By registering for a team and signing the MCA agreement, you are
committing to ALL competitions decided on by the owners and coaches. The only exceptions are
contagious illness and death in immediate family.
Meeting times will be announced via email and in the viewing area as soon as possible, according to
when the competition companies post them.
It is your responsibility to know when and where the athletes will be meeting.
Upon arriving at the competition location, please be ready to compete (fully dressed) unless otherwise
instructed by your team coach.
Team member’s hair should be worn according to the standard set by MCA. This will be given at a later
Make up should be applied according to the standard procedure set by MCA. Only make up designated
by MCA should be used.
Jewelry is not allowed during warm up or competition, which would include all piercings. This is for
safety reasons not only enforced by MCA and competition companies. During competitions, penalties
can be assessed to our team for wearing jewelry. No special exceptions will be made. No bandages
will be allowed over jewelry. It is not the responsibility of MCA staff or team parents to care for your
personal jewelry items.
Team members are to be in full uniform at the awards ceremonies (no sandals, slippers, bags, or
pants). This means that you will not go on stage in your team sportsbra.
Parents, relatives, friends, and cheerleaders are not allowed to speak with competition officials for
Parents are required to set an example to not only their own athletes, but to all of our team members.
Please make sure that your actions do not interfere with the responsibilities that you have as a
representative of MCA. We would not want any athlete to be removed from the program because of the
actions of their parents. We would appreciate you support.
A true family supports each other in all situations. We, at MCA like to think of you as our family. At
times throughout the season athletes will be required to arrive early and stay late. This is not
negotiable. Athletes appreciate the noise and the support of all of you.
I have received a copy of the Mississippi Cheerleading Academy Registration
Packet. I have read all of the information provided in this packet and agree to
abide by all the rules and regulations. In addition, I will commit myself to the time
involved in practice, camp and competition. I am fully aware that competitive
cheerleading is a large financial responsibility and I will commit to MCA as per the
financial requirements of a team member. I further acknowledge that I am aware
that actions that do not align with the expectations of MCA according to the rules
and regulations could result in removal of the athlete. In order to be successful
this season, I will commit to Mississippi Cheerleading Academy with a POSITIVE
Photo Release Form Policy
When Parents register at Mississippi Cheerleading Academy, LLC. they understand that when
participating in activities the registrant may be photographed for print, video or “electrical images”.
Parents also understand that the images may be used in promotional materials, news releases and
other published formats.
I, being the parent/guardian of ___________________ hereby consent that photographs and/or
videotapes may be used by MCA in whatever way they desire, including television or electrical uses.
Furthermore, I hereby consent that such photographs or films shall be their property, and they shall
have the rights to sell, duplicate, reproduce and make other uses of such photographs or films as they
desire free and clear of any claim whatsoever on my part.
Parent/Guardian’s Signature Date
We invite you to join our convenient, automatic payment program, which automatically transfers your balance due
from your checking account to Mississippi Cheerleading Academy, LLC. when each payment is due. Athletes are
required to complete the form and provide MCA with a voided check from your checking account.
Mississippi Cheerleading Academy will draft your fees on the 5th of each month.
If your direct payment options fail, your athlete will sit out of practice/competitions until your account
becomes current, regardless of the time of year.
Any outstanding balances at the end of the season will be turned over to a collections agency.
If your child participates in a tumbling session, your account will be drafted regardless of your child’s
attendance for the three month session. If you wish to withdraw from the academy you must notify MCA
2 weeks prior to the 5th of month (draft day).
All-Stars will be obligated to withdraw competition fees from June to February unless you pay in full.
Any athlete who wishes to add or remove any fees from the Direct Pay system must notify MCA in WRITING
no less than 10 days prior to the next rescheduled payment, for payment of a recurring or one-amount.
Furthermore, if any such debit(s) drawn off of the checking or savings account is returned NSF
(non sufficient funds), I authorize Mississippi Cheerleading Academy to collect debit(s) by
electronic debit and subsequently collect an electronic per item returned NSF fee not to exceed
the state allowable amount from the account identified below. A charge of $10.00 will be added
to your monthly fee if your monthly draft is returned NSF. You will be obligated to pay your
monthly fee plus the additional $10.00 fee to the gym by the end of the month, or your child will
sit out of practice until your balance becomes current.
Athlete’s Name________________ Parent’s Name__________________
I authorize Mississippi Cheerleading Academy to withdraw funds from my:
□ Checking Account
I am duly authorized check signer or authorized credit card user on the account identified below, and
authorize all of the above with my signature below.
Financial Institution Name:__________________________ Branch:________________
Routing Number:________________________ Account Number:__________________
The authorization shall remain in full force and effect until MCA has received written notification
from me of its termination in such time and in such manner as to afford MCA a reasonable opportunity
to act on it.
Account Holder’s Signature____________________________ Date:_______________________
□ All-Star Tuition □ School Squad Discount □ Tumbling Tuition:
Team:__________ Squad:___________________ Class time and Day: ___________________
Total Amount Drafted:____________ Office Worker Init._______ Card Holder Init._____________
□Medical Release Form
□Voided Check and Draft Form
□Registration Fee $25- Cash or Check
Your tuition payment will be drafted on the 5th of each month.
Your first payment will be drafted in May for $100.00. All-Star
tuition includes 2 All-Star practices and 1 free tumbling class.
Make sure you read about the tumbling session in the draft form.
When you sign-up for a tumbling session you will be drafted for
the entire 3 month session.
We look forward to seeing you at the gym!