SPIRIT CENTRAL - REG & RELEASE - Spirit Central Cheer

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Parent / Guardian Information

Parent / Guardian Name*

First Last

Email*

Primary Phone*

Secondary Phone*

Address*

Street Address City State ZIP Code

Emergency Contact Name*

First Last

Emergency Contact Phone*

Athlete Information

Athlete Name*

First Last

Athlete Date of Birth*

Please list any physical/psychological limitations, injuries or weakness that may affect the athlete:*

List All Allergies:*

Please Select Which Medications Your Child May Take:*

Tylenol

Advil

Motrin

None of the above

Doctor Name*

Doctor Phone Number*

Preferred Hospital For Treatment:*

Insurance Carrier*

Policy #:*

Insured’s Name*

First Last

Membership #:*

Authorization & Release

AUTHORIZATION AND RELEASE*

I/we understand that by participating at Spirit Central, Inc. and or by joining Spirit Central, Inc., either on a team, classes, individual or any other activities/participation, there is a possibility of injury to my daughter/son. With this understanding, I give my child,________________________________________________________________
permission to participate and attend any activities held at Spirit Central, Inc. or traveling with Spirit Central, Inc. to other locations.
I/we authorize Spirit Central, Inc. and its representatives to consent to medical treatment for my child,__________________________________________________________,
when I or my emergency contact can not be reached to give consent. I also give permission to Spirit Central, Inc. permission to administer emergency care to my child to stabilize and/or improve the current injury or condition that my child may sustain during activities related to Spirit Central, Inc. instruction, practices, camps, clinics, competitions, traveling and all other activities. I release Spirit Central, Inc., owners, coaches and staff from any harm associated with the care of my child.
I/we the undersigned parents/legal guardians agree to forever release the Spirit Central, Inc. owners, Board of Directors, Coaches, Employees, Volunteers from any claims, actions, right of action, damages, costs, loss of service, expenses, compensations and attorney’s fees that may have risen in the past, or arise from the future, directly or indirectly from known or unknown personal injuries due to participation in any and all programs, classes, teams, camps, clinics, competitions or other activities associated with or at Spirit Central, Inc. We further release against any and all legal claims and proceedings of any description that may have been asserted in the past, or may be asserted in the future, directly or indirectly, including damages, costs and attorney’s fees arising from my child’s participation with Spirit Central, Inc. in the gym or while traveling and participating in outside activities.

I/we further confirm that we have read this consent and release liabilities and that I/we understand the contents of this agreement. I/we understand that my child’s participation in this event is voluntary and that participants are free to not participate in Spirit Central, Inc. programs/events. I/we understand that if I/we do not follow all the rules set forth by Spirit Central, Inc. owners, coaches and staff, that my child’s membership from Spirit Central, Inc. may be terminated. All membership fees are non-refundable.

I understand that being involved in any activities at Spirit Central, Inc. that my child’s photo and/or name may appear in advertisements, flyers, year books, videos and/or the Spirit Central, Inc. website. The initials of the child’s last name may be used on the website. Full names will be omitted.

I understand and agree to the statements listed above.

Parent's Signature*