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FlyerRegistration Form Young Champions

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FlyerRegistration Form Young Champions Powered By Docstoc
					                                                                                                                            
                                                                      Saturday                                                      Barker Middle School
                                                                                                                                           319 Barker Road
                                                                   February 5, 2011                                                  Michigan City, Indiana 46360

                                                                                                                            

                                                              $30.00 Registration Fee
                                                          PRE-REGISTRATION ONLY PLEASE!
                                                              Do NOT give this form or fees to your coach.
             No spectator fee for those that come to show support for their child’s team. Remember your camera, camcorder and good sportsmanship!
                                 No Food or Drink is permitted on the premises; concessions will be available throughout the day!
                            Order your engraved tape for your child’s trophy for only $5.00 (pre-order or order the day of the event).
                 DEADLINE TO PRE-REGISTER: Thursday, January 27, 2011
                                                    Registrations received after this date will be charged a $10.00 late fee.
                                           THIS IS A NON-REFUNDABLE & NON-TRANSFERABLE REGISTRATION FEE
                                                Mail Registration Form, Entry & Engraving Fees to:
                                                             Young Champions / INDIANA
                                                         165 54th St. SW, Wyoming, MI 49548
                                                              Make Check/M.O. payable to: Young Champions
                                                            1-800-940-7469      WWW.YOUNGCHAMPIONS.US
                  Our trophy order is determined by pre-registered student totals. Please pre-register to alleviate trophy shortages.

                                         DIVISION                               PRACTICE TIME                                                   PERFORMANCE TIME
                                         1                                             8:00 A.M.                                                      9:00 A.M.
                                         2                                             11:00 A.M.                                                     12:00 P.M.
                                         3&4                                           2:00 P.M.                                                      3:00 P.M.

                                                   *PLEASE PICK UP ENGRAVING TAPE AT THE ENGRAVING TABLE AT COMPETITION*

                                                  DETACH AND RETURN THE FORM BELOW TO YOUNG CHAMPIONS
                 Please check yes or no if you would like the engraved tape for your child’s trophy. $5.00                                                    Yes __                    No__
                                      The name listed on this registration form is the name that will be placed on the engraved tape. Please write legibly.


Please check the division your child will be competing in:
Division 1 __            Division 2 __             Division 3 __             Division 4 __

Students Name
Address                                                                                               City ___________________________State ______ Zip
Phone (                  )                                                                Coach

Pay by Check ___                      M.O. ___                  Please see reverse side if paying by credit card.
Registration $30.00 __              Engraving $5.00 __          Tee Shirt $12.00 __       Late Fee $10.00 __                    Total Amount Enclosed $


                                THE WAIVER BELOW MUST BE SIGNED FOR YOUR CHILD TO BE ELIGIBLE TO PARTICIPATE.
Young Champions, Inc, Liability Release: I, the parent of the student listed above, do hereby agree to release all liability & claims against the Young Champions Inc. organization, & agree to hold harmless any
liability against Young Champions Inc., any sponsoring organization, facility, instructor and any other party involved, due to any injuries, accidents, negligence, or any other circumstance arising from
participation in this program with respect to any time prior, during and after the class, including participation in all Young Champions Inc. events such as parades, performances, clinics, competitions,
demonstrations, tournaments, etc. Parents and/or YC may take photos or videos of classes, parades or special events for personal/company use. I understand my child may be photographed. YC reserves
the right to refuse service to any customer for any reason.

Parent Signature: ____________________________________________________________________ Date: _______________

                                                                            INDIANA CHEER COMPETITION
CREDIT CARD INFORMATION – Please fill out completely.

MasterCard __     Visa __       Registration $30.00 __   Engraving $5.00 __   Tee Shirt $12.00 __   Late Fee $10.00 __

Total Amount to Charge $

Name on card

Billing Address                                                      City                                       State              Zip

Credit Card #                                                                                       Exp. Date            3 Digit Security Code

Signature

				
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posted:3/12/2011
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