Parents and {squad name} Cheerleaders

1.  This completed form is MANDATORY for the participation in anything the {squad name} is involved with.
Please read it carefully and sign where indicated.

2.  The {squad name} is covered by insurance with Perkins Slade Ltd. Policy number : _____________

Cheerleaders Name: ___________________________

Full Address: _____________________________________________________

In case of emergency, notify: __________________ Phone: _________________

                                       or: __________________ Phone: _________________

Vigorous Activity: As part of the {squad name} you will be participating and being involved in a vigorous athletic activity which will include stunts, mounts, gymnastics, jumps and dance. Due to the nature of the activity we wish to inform you that the possibility of injury does exist as with any other athletic activity.   All reasonable care will be taken by the club and staff.

Medical issues: If there are any special medical considerations that club staff should be aware of these should be notified in writing to the club.   Medications that may be required by your child must be supplied in a sealed bag with their name on, with specific authorisation given to the club on giving such medication.

Photographic consent: {squad name} may take part in BCA authorised competitions where BCA approved and CRB cleared photographers and video crew will photographing and videoing routines.   If you do not want your child included in official photographs and event videos please indicate below.
Photographic / video consent:             Y / N     (circle)

Cheerleader Representation:  I agree to co-operate with the coach and squad officials and will follow the instructions and rules in accordance with their directions. I understand that failure to obey the rules and instructions of the coach and squad officials may result in my dismissal and discharge from the squad without reimbursement of fees. As a cheerleader I understand that I am free to withdraw my participation upon my request and at my own free will without coercion, duress or intimidation of any sort.

Cheerleaders Signature: _________________________ Date: ____________

Parental Consent:  I/we authorise the coach or squad officials of the {squad name} to seek treatment for any injury occurred by my child whilst cheerleading and also authorise the doctor and/or hospital nearby to perform treatment to any injury.

I/we have read the above and understand the risk of vigorous athletic activity. Our child is in good health and physically capable of participating as part of the {squad name}.

Parent/Guardians Signature: ______________________ Date: ____________

If the cheerleader is over 18 years of age parents signature N/A.