Chamblee Charter High School  Cheerleading Information Form/Medical Release Form
Please Fill out the form below, this form will also determine your tryout number that you will receive the day of tryouts.
Cheerleader Name *
Birthdate *
MM
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DD
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YYYY
Rising grade *
Trying out for: Please check any that apply  (*You will only be considered for the squads you choose. Should you choose varsity basketball and JV,    precedence will be given to varsity basketball if you qualify for both.) *
Required
Please mark your most recent stunting position: *
Required
Parent/Guardian Name: *
Address: *
Guardian 1 #: *
Guardian 1 alternate #: *
Guardian 2 #: *
Guardian 2 alternate #: *
Cheerleader Cell #: *
Emergency Contact- Someone other than primary guardians (Name and Phone Number) *
MEDICAL SITUATIONS: Please list any medical situations about which the coaches should be aware. Please include any medications the candidate takes and any medications he/she cannot take: *
MEDICAL AID PROVISION: We do hereby give permission for the cheerleading coach to secure whatever emergency medical treatment my child needs at any time during practice, or home and away games. *
I will assume financial responsibility for expenses involved in this treatment. *
Insurance Company and Policy Number *
Do you plan to let your cheerleader attend camp in July at Great Wolf Lodge in LaGrange, GA? *
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