Xtreme Heat All-Stars

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2020-2021 Registration/Commitment Form Season #10

Email *

Athlete First Name *

Athlete Last Name *

Athlete Date of Birth *

YYYY

Names of Parent/Legal Guardian *

Primary Phone *

Secondary Phone

Address *

City *

Emergency Contact Name *

Emergency Contact Phone *

Health Insurance Company *

Policy Number *

Please list any serious injuries, surgeries or illnesses. *

Please list any medical conditions and allergies *

Please list any medications your child currently takes. *

Please list all tumbling skills that your child can do unassisted. *

Please list any experience your child has in stunting and what level (example level 1 flyer and level 2 main base) *

Would you like for your child to be considered for a crossover? (more than 1 team) *

Yes

Maybe

It is possible for the Elite All-Star teams to win a bid to the D2 Summit at Disney World in May 2021. Would you like for your child to be considered for an Elite All-Star team? *

Yes

Maybe

I have read the release of liability waiver and I understand the risks associated. I release Xtreme Heat All Star Cheer of all liabilities associated with participation. *

I have read and agree to the release of liability.

Required

I have read and understand the policies and expectations outlined in the 2020-2021 Xtreme Heat All-Star Cheer Policies. *

I have read and agree to the policies set forth.

Required

Photo Release: I understand that photos/videos may be taken during practice, classes, competitions and other gym activities. I give my consent for them to be posted by Xtreme Heat's coaches to social media and website. *

I give consent for photos/videos to be posted.

Required

Full Name of person completing this form. By typing my name below, I am committing to the 2020-2021 season with Xtreme Heat All-Star Cheer. As the parent or legal guardian of the athlete I am registering, I am acknowledging that I fully understand the policies and expectations and I agree that I and my child will be fully committed for the entire cheer season (May 2020-May 2021). *

A copy of your responses will be emailed to the address you provided.

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