Student Name * Age as of Aug 31, 2011 * Birthday * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015 Years of Experience * - Select -1234567891011121314151617181920 This application is going to be used to decide our teams for the 11-12 Season. Please fill out everything on this application and sign the bottom. If anyone is cheering on 2 teams, the only extra fees will be the Organization’s Crossover Fees. Remember the coaches will pick the teams, and will decide on which team or teams the cheerleaders will be cheering on this year. DO NOT contact any coach except Roland, if you have any questions about the teams. Number of Teams * - Select -12 Non Travel Team * - Select -YesNo Parent Signature * This text field will be your electronic signauture for this online "Cheer Zone All-Star Application" Signature Check Box * Yes By checking this you agree that you have filled out this online form truthfully and agree to the terms of this online form. Registration & Waiver Form Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20112012201320142015 Billing address * City * Indiana * Home Phone * Cheerleader Cell * Mother's Name * Mother's Day Phone * Mother's Cell * Father's Name * Father's Day Phone * Father's Cell * Email * Emergency Contact * Phone Number * Health Insurance Company * Policy Number * Family Doctor * Doctor's Number * Do you have any medical problems that may interfere with your participation in The Cheer Zone Program? If yes, will you have medication with you (please describe). Voluntary Hold Harmless AgreementThe Cheer Zone has made available its facilities in Evansville, Indiana for private use for a voluntary sports/social activity. This is a purely voluntary activity, and you have voluntarily chosen, without pressure or compulsion, to be involved in this activity. By signing this form below, you expressly understand and agree to the terms of this Agreement. You, the undersigned, do hereby indicate your full understanding that the sport/social activity you and your child/children are to engage in may present the possibility for personal injury or damage to you, your child, or your property. Although there will be adult supervision present, you also understand that the facility contains certain items intended for athletic use, such as a trampoline, exercise mats and floor, and other items which could present a danger if not properly used or properly maintained. You, the undersigned, hereby indicate that you understand the associated risks and that you are assuming and accepting full responsibility for those risks. Understanding the potential dangers inherent in any such physical activity or the use of such a facility, you hereby accept those potential dangers, and hereby agree to hold harmless The Cheer Zone, its owners, employees and volunteers, and all persons associated with this event, form any and all liability, claim, demand, or cause of action which you may have on behalf of yourself or your child/children associated with this event, or occurring while on the premises. By your signature below, you are indicating your full understanding and agreement that The Cheer Zone, its owners, employees, volunteers, or other persons supervising this event, shall have no legal liability for any injuries, loss, or damage to persons or property which may occur during the event. You further agree and hereby state that your child/children is/are in a reasonable state of physical condition such that they can safely take port in this activity. For Valuable Consideration, the undersigned and their heirs and assigns, agrees to forever release, discharge, indemnify, defend, and hold harmless The Cheer Zone, its owners, employees, volunteers and agents, and the supervising personnel, form any and all claims or damages for personal injury, death, or property damage arising out of the undersigned’s participation in these voluntary activities, whether caused by the acts or omissions of the undersigned’s or any other party while involved and participating in the activity. I have read the"Voluntary Hold Harmless agreement" above * Yes Parent Name * Parent's Address * Parent's City * Perent's State * Parent's Phone Number * 1st Child's Name * 2nd Child's Name 3rd Child's Name This hold harmless agreement shall be effective immediately, and shall be valid for the activity period May 2011 – April 2012. Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20112012201320142015 Parent/Legal Guardian Signature * This text field will be your electronic signature for this online "Cheer Zone Voluntary Hold Harmless Agreement Form" Signature Check Box * Yes By checking this you agree that you have filled out this online form truthfully and agree to the terms of this online form.