EmailMe Form - Mariner Jr Cheer Registration (Sideline)

Child's Name *

First Last

Child's Birth Date *

MM / DD / YYYY

AGE *

Name of School attending *

Primary Parent/Guardian Name & Info

Parent Name (Primary Contact) *

First Last

Phone *

### - ### - ####

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Secondary Parent/Guardian Name & Info

First Last

Phone

### - ### - ####

Email

Medical and Emergency Info

Preferred Hospital/Facility: *

Medical Conditions (N/A if none): *

Allergies (N/A if none): *

Medications (N/A if none): *

Consent & Waivers

Medical Authorization - Grant of Consent *

I have read the follow and give my consent

I hereby certify that my child is in good health and may participate in all activities. In case of emergency, I give my permission for my child to be given emergency treatment at any accessible hospital.

Liability Waiver *

I have read the follow and give my consent

As the parent (or legal guardian) of the above named minor, I grant permission for the minor to participate in all activities of the sports program. I assume all risk and hazards incidental to such participation, including transportation to and from such activities, and do hereby release and waive all claims against Mariner Jr Cheer, Mariner High School, Sponsors, volunteers, agents and other participants.

HB 1824 Compliance Statement *

I have read the follow and give my consent

I have been provided with information on concussions in youth sports. If the player is suspected of a Head injury or Concussion, the player will be removed from play. The player will be kept from play until given permission to return to play by a health care provider.

www.cdc.gov/ConcussionInYouthSports

Image & Social Media Waiver *

I have read the follow and give my consent

I do NOT want my child's photos shared/posted

I agree images of my child may be used by Mariner Jr Cheer in promotional publications, and social media sites.

Payment Method
(In what way do you intend to pay your remaining balance) *

Debit/Credit Card

Cash

** Must be paid in FULL before Uniform will be checked out - NO EXCEPTIONS!

Refund Policy *

I understand there are NO Refunds!

Do you have a sibling in the Mariner Jr Football Program? If so, who?

Are you new to the Mariner Jr Cheer Program? If so, how did you hear about us?