Cheerleading Registration

Chearleader Information

Please provide the requirement information for the athlete.

Chearleader’s Full Name

Gender

Male

Female

Grade

Date of Birth

Address

Street

City

State

Zip Code

T-Shirt Size

Guardian Information

Please provide the guardian information.

Mother/Guardian’s Name

Mother/Guardian’s Email

Mother/Guardian Phone Number

Relation to Athlete

Mother/Guardian Would Like to Volunteer

Yes

Father’s Name

Father’s Phone Number

Father Would Like to Volunteer

Yes

Emergency Contact Information

Please provide information for the emergency contact.

Contact’s Name

Contact Phone

Relationship to Athlete

Medical Information

In case the parent/guardian is out of reach at the time of emergency, with consent of the latter, we will exercise the required diligence needed to have the athlete treated by an ER Physician. In this regard, we would like to get to know any precautions that we need for the athlete.

Family Doctor

Doctor’s Phone Number

Medical Information (Allergies/Medications)

Confirmation/Consent

Please read carefully before continuing.

By submitting this form you give your consent for your child’s participation in any and all Patterson Recreation functions or activities. In the event of any injury or sickness occurring during any Patterson Recreation functions or activities, you authorize any official(s) to administer first aid and if necessary to transport your child to the nearest emergency treatment.

You release Patterson and any person(s) connected with Patterson Biddy of any responsibility from accident or injury incurred as a result of his participation in any and all activities, including transportation to Patterson Biddy activities. You certify that you child has been given a physical examination and is physically able to participate in all related activities. Please notify in writing any prescribed medications and / or physical conditions of which coaching staff should be aware of are listed below.

In any way in the Patterson basketball program related events and activities, the undersigned acknowledges, appreciates, and agrees that: The risk of injury to my child/ward from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, I FOR MYSELF, SPOUSE, AND CHILD/WARD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child/ward’s participation; and, I willing agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child/ward’s readiness for participation and/or in the program itself, I will remove my child/ward from the participation and bring such attention of the nearest official immediately; and, I for myself, my spouse, my child/ward, and on behalf of my/our heirs, assign, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Overtime Trainers basketball; Its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leasers of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child/ward’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I, for myself, my spouse, my child’s/ward, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my child’s/ward involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. I, parent or guardian of the above named candidate for participation in the basketball program, hereby give approval for any and all activities during the current season. I assume all risk and hazards incidental to such participation including his/her transportation to and from the activities and do herby waive, release, absolve, indemnify, and agree to hold harmless the local league organization, the organizers, sponsors, schools, supervisor, participants, and persons transporting the player to and from activities for any claim arising out of an injury to the participant. I will be responsible to assure that my child is physically able to participate in the program prior to enrolling.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I consent

Yes

Waiver. I am aware that any physical sport activity may cause accidental injury or harm among the athletes, and I assume any and all possible risk that may cause injury, illness, or death arising to such activity. I agree to waive my right to pursue any claim against the Commission and the Organizing Committee of this event.

Parent / Guardian’s Initials

Payment

Payment and registration. After payment, you will receive a confirmation email. Please make sure that you check the spam folder if you don’t receive the confirmation in 10 minutes.

Your Name

Email

Registration Fee

Price: $50.00

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