Loading...

Acknowledgement, Authorization and Release Form

In consideration for the participating athlete in the activities provided by Just Cheer, including but not limited to all aspects of cheerleading, tumbling, trampoline, and dance training and/or competition, I am fully aware that any activity involving motion, height, or athletic activity creates the possibility of serious injury and/or death. I hereby release Just Cheer, including its officers, shareholders, agents, and employees, from any liability to the above-named athlete, of the person claiming through him/her, arising from injury to the person or property of the above-named athlete occurring on the premise of Just Cheer, including any event sponsored or sanctioned by Just Cheer, and/or travel to and from such activities. This release includes but is not limited to any claims of negligence, dangerous condition, latent defect, premises liability, code violation, negligent security, failure to warn, vicarious liability, negligent hiring, negligent supervision, negligent maintenance, or improper/ dangerous equipment; it is intended to be as broad as permissible under New Jersey Law. I am fully aware of the nature of the activities provided and the possibility of injuries arising from such activities. I further agree to hold harmless, indemnify and defend Just Cheer, including its officers, shareholders, agents, and employees from any loss, liability, damage, or cost incurred by them due to the above-named athlete on the premises or during any event sponsored or sanctioned by Just Cheer. This release is intended to be binding upon the athlete, his/her heirs, assignees, and successor in interest, and anyone claiming by or through him/her. In addition, I give Just Cheer permission to film, photograph, or videotape the above athlete for any reproductions, movies, televised events, or promotional print associated or in any way connected with Just Cheer. I have read and understood the registration form and agree to all terms as stated above. I also attest that all information given is factual. I certify that the athlete is in good health and may participate in any Just Cheer activities. In case of an emergency requiring medical treatment, the undersigned hereby authorizes Just Cheer to take the above-named athlete to a qualified medical or hospital facility for care and treatment.  

Date: September 21, 2023

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Please list any physical/psychological limitations, health conditions, injuries, or weakness that may affect the athlete’s participation or performance:

Allergies:

Medications (please list all):
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Please list any physical/psychological limitations, health conditions, injuries, or weakness that may affect the athlete’s participation or performance:

Allergies:

Medications (please list all):
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Please list any physical/psychological limitations, health conditions, injuries, or weakness that may affect the athlete’s participation or performance:

Allergies:

Medications (please list all):
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Please list any physical/psychological limitations, health conditions, injuries, or weakness that may affect the athlete’s participation or performance:

Allergies:

Medications (please list all):
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Please list any physical/psychological limitations, health conditions, injuries, or weakness that may affect the athlete’s participation or performance:

Allergies:

Medications (please list all):
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Please list any physical/psychological limitations, health conditions, injuries, or weakness that may affect the athlete’s participation or performance:

Allergies:

Medications (please list all):
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Please list any physical/psychological limitations, health conditions, injuries, or weakness that may affect the athlete’s participation or performance:

Allergies:

Medications (please list all):
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Please list any physical/psychological limitations, health conditions, injuries, or weakness that may affect the athlete’s participation or performance:

Allergies:

Medications (please list all):
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Please list any physical/psychological limitations, health conditions, injuries, or weakness that may affect the athlete’s participation or performance:

Allergies:

Medications (please list all):
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Please list any physical/psychological limitations, health conditions, injuries, or weakness that may affect the athlete’s participation or performance:

Allergies:

Medications (please list all):
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Insurance

Insurance Carrier*

Insurance Policy Number*
Additional Information
Select one:
All Star Program
Camp/Clinic/Choreo
Class/Private Lessons

For Camps/Clinics/Choreo please list the program you’re attending with
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
EMERGENCY CONTACT INFORMATION

Name *

Phone #: *

Relationship to Athlete: *
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Please list any physical/psychological limitations, health conditions, injuries, or weakness that may affect the athlete’s participation or performance:

Allergies:

Medications (please list all):
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!