"Cheerleading Certificate Template"
Medical Form Camper's Name NCCU CHEERLEADING ________________________________________________________ CAMP All campers must have their own medical coverage. If this is not the case, a parent needs to sign the insurance waiver below. Insurance Waiver I (We) the parent (s) of _______________________________ do acknowledge that I (we) will be responsible for any medical expenses that may become necessary during our child’s partici- pation in the NCCU Cheerleading Camp (s). Medical Insurance Information ___________________________________________________________________ Insurance Co. Policy # __________________________________________________ Policy Holder Phone # www.NCCUEaglePride.com ___________________________________________________________________ Parent Signature Date I/We, the undersigned, for ourselves, our heirs, executors and administrators, waive, release and forever discharge the North Carolina Central University Cheerleading Camp and its staff, officers, agents, employees, representatives, successors and assignees of and from all rights and claims for damages, inju- ries, or loss of person or property which may be sustained or occur during participation in camp activities or while at camp. DOCTOR’S PERMISSION: This will certify that the camper named above is physically qualified to attend the 2009 NCCU Cheerleading Camp (s). June 23-25 & July 27-31 ________________________________________________________________________________ North Carolina Central University Physician’s Signature Date McLendon-McDougald Gymnasium *A note from a physician or a school physical from this school year (2008-09) may be used in lieu of the Physician’s Signa- ture on this form; however, no camper will be allowed to participate without a doctor’s permission. Please enclose the requested forms with the registration information. Camp Information Registration Form Registration Information This three day camp will focus on technique, Pre-registration is requested by Please Circle One: June 23-25 July 27-31 sportsmanship, creativity, school spirit, motions, healthy eating, conditioning and balancing aca- mailing the registration form along Ages 12-17 $65 Ages 4-11 $125 demics with athletics. Camp instructors are cur- with all fees to: _______________________________________________ rent members of the Varsity Cheerleading Squad Name Age and will provide professional and personable NCCU Cheerleading Camp instruction. We will provide a safe and nurturing ATTN: LuAnn Edmonds-Harris _________________________________________________________ environment throughout the camp. Home Address North Carolina Central University Lunch will be provided on campus in the newly 1801 Fayetteville Street _________________________________________________________ City/State Zip Code renovated W.G. Pearson Cafeteria. It is an all you McLendon-McDougald Gymnasium can eat setting and we will encourage participants Durham, NC 27707 _________________________________________________________ to choose foods School Grade that will provide healthy bodies _________________________________________________________ Parent/Guardian for athletes. Par- ticipants may _________________________________________________________ bring “snacks” for Home Phone # Alternate Phone # breaks throughout the day. _________________________________________________________ The majority of the instruction will be in the Emergency Contact McLendon-McDougald Gymnasium. On Friday, _________________________________________________________ June 25th (July 31, second session), we will hold Emergency Contact Phone # an exhibition for parents, friends and the NCCU family. It will begin at 4pm and pictures and video are allowed. All camp participants will re- ceive a certificate of attendance and an invitation to cheer at one of our home football games. We will not teach nor perform any stunting or tum- *The NCCU Cheerleading Camp is open to any and bling activities during the camp instruction. all participants. For more information please visit www.NCCUEaglePride.com