PREMIER ALL STARS ALLSTAR CHEERLEADING /DANCE June- 2013-April- 2014

REGISTRATION INFO:
All Fees NON_REFUNDABLE: We Accept Checks, Cash, and CC with $5.00 processing fee. Registration Fee: $75.00 (includes team T- Shirt) Family Registration Fee: $115.00 (Includes team T-Shirt per child) *** ADDITIONAL CHEER FEES NOT INCLUDED*** Cash Money Orders, checks Payable to: Premier All- Stars

CHEERLEADERS INFORMATION (PLEASE PRINT CLEARLY) LAST NAME FIRST NAME DATE OF BIRTH STREET ADDRESS CITY STATE ZIP CODE

SCHOOL ATTENDING IN FALL 2013 & GRADE PARENT/GUARDIAN INFORMATION (PLEASE PRINT CLEARLY) GUARDIAN NAME (FIRST & LAST) HOME NUMBER EMAIL ADDRESS WORK NUMBER CELL NUMBER

ALTERNATE EMAIL ADDRESS

F GUARDIAN NAME (FIRST & LAST) A T H HOME NUMBER WORK NUMBER E R EMAIL ADDRESS

CELL NUMBER

ALTERNATE EMAIL ADDRESS

CHEER REGISTRATION: AGE:______ as of 9/30/2013 Registration Fee: _______ Discounts: _____ Competition fee: ______ Uniform Size: _________ T- Shirt Size: _________ Sports/ Bra:_______ Lime green Tee: ____ Black Tee:_____ Shorts: ______ Socks: ___ Shoes:______ Hair bow:___ Make- Up:_____ Bag: _____ Jackets: ___

3-5 yr. old Tiny Twinkles: ___ 6-11 yr. old Sparkles: _____

12-14yr Shining Stars: ____

15 and up Shooting Stars: ____

SIBLING #1 __________________________________________________________________________ DIVISION _____________________ SIBLING #2 ______________________________________ DIVISION ____________________

PAYMENT AMOUNT

PAYMENT TYPE

RECEIPT NUMBER

ACCT INITIALS

Page | 1

EMERGENCY MEDICAL RELEASE & AUTHORATION

In case of an emergency, when I cannot be reached, PASC/POGA has permission to take this participant to the nearest hospital emergency room and obtain medical attention that is deemed necessary for their well-being. I acknowledge, understand, and agree that this authorization is to be used only in emergency situations when I cannot be contacted or am not present, and I hereby hold PASC/POGA and its representatives harmless in the exercise of this authority. PLEASE INITIAL ______________ Please list any allergies, medications, physical, psychological or emotional conditions that might affect your childs participation: _________________________________________________________________________________________ ___________ ___________________________________________________________________________________________ PARENT/GUARDIAN ACKNOWLEDGMENT AND OTHER RELEASES ____________ 1.
2. 3. 4. 5. I understand that registration fees are non-refundable. I do hereby consent for this child to participate in all activities with PREMIER ALL-STARS. To the best of my knowledge, the enrolled participant is in good physical and emotional health. I understand I am responsible for picking up my child from all activities, Competitions and practices on time. I understand fundraising is a way of generating funds to maintain and improve our organization. Team fundraising is not mandatory but highly encouraged and individual fundraising will be an available activity for each participant to receive discounts in up-coming events and product. Practice & Financial commitment is a Must!! If attendance becomes an issue a child may be removed from the team. This is a team sport that requires regular attendance. Attendance will be handled in a case-by-case basis at the discretion of Gym Staff and the Gym Owner. Please note that failure to pay fees timely can and can result in your childs termination from the team. I understand that Premier All- Stars Staff/Coaches will help to maintain and enforce a policy of LESS DRAMA! If there becomes a problem, All-Star staff and coaches maintain the right to ask both parent and child to leave the facilities and forfeit right to be part of the program with no refunds. ZERO TOLERANCE POLICY - Any squad member, coach, assistant coach or parent/guardian who shows the following behavior: fighting, abusive language, confrontational with a staff members will be made to leave and will lose right to participate. Cheerleaders shall refrain from taunting, criticizing or jeering at opposing squad members or their own. There will be no badgering, name calling, or use of foul language directed at a coach, teammate, or spectator. No smoking, drinking, this will not be tolerated. All can and will result in severe consequences. I understand accidents do happen but the staff and coaches of both PASC/POGA will do everything to ensure the highest safety measures as possible. As the legal guardian of the child registered on this form, I hereby consent for him/her to participate in cheerleading/tumbling classes conducted by POGA/PASC. I recognize that any activity involving rotation, height and motion can create the possibility of catastrophic injury, including paralysis and even death. I hereby forever release the POGA/PASC, its officers and employees, from all liability and for any and all damages and injuries contracted with cheerleading practices/tumbling, camps and/or events.

6.

7.

8.

9.

10. PREMIER ALL-STARS will periodically display pictures of the cheerleaders on its website/Facebook/Twitter: I will allow my childs picture to be displayed with no reference to my childs name. I will not allow my childs picture to be displayed

YOUR SIGNATURE BELOW INDICATES YOU HAVE READ, UNDERSTOOD AND WILL ABIDE BY ALL INFORMATION AS STATED ABOVE.
Parent/ Guardians signature: ____________________________________ Date: ___________ Relationship:______________________ Print: ___________________________________ Participant Signature ___________________________________________ Date: __________ Page | 2

Page | 3