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TEXAS ALLSTAR CHEER & DANCE

(ALLSTAR CHEER & DANCE OF TEXAS, INC.)

325 Ed Schmidt, Hutto, Texas 78634

Parental Permission / Release of All Claims /

Consent to Medical Treatment / Consent to Publish

TUMBLING CLASSES AND TAC TEAMS

Please read and sign the following:

I/we the parent(s)/guardian(s) of the above mentioned Child (whether one or more) do hereby grant permission for the Child to participate in any and all cheerleading, tumbling, dance and/or other physical activities (whether one or more, “activities”) while a student at TEXAS ALLSTAR CHEER, whether at or away from the training facility of TEXAS ALLSTAR CHEER (address set forth below - “training facility”). I/we represent that the Child is physically able to participate in the activities without limitations. I/we acknowledge and agree it is my/our responsibility to promptly inform TEXAS ALLSTAR CHEER in writing of any health updates regarding the Child throughout the year.

I/we give TEXAS ALLSTAR CHEER the right and permission to film, photograph, or videotape my/our Child or me/us for any reproductions associated or in any way connected with TEXAS ALLSTAR CHEER (including any form of advertisement or promotional purposes).

The Child will be coached, instructed and conditioned to compete at the peak of his/her ability. Along with competition and effort to acquire excellence is the reality of possible injury. I/we understand that there is personal risk involved in any activity that includes motion or height and that these activities can result in SEVERE INJURIES, DISABILITY OR EVEN DEATH. I/we, the parent(s)/guardian(s) are assuming full responsibility for the Child’s personal safety and I/we do hereby release and hold harmless TEXAS ALLSTAR CHEER, its employees, supervisors, instructors (whether paid or volunteer), agents, invitees, employees, officers, directors and shareholders from any and all claims, demands, actions, expenses (including attorney’s fees, threatened or incurred), judgments, executions and liabilities that may occur from any injury, accident and/or incident (known or unknown), including death to the Child, that may arise as a result of the Child’s attendance at the training facility or as a result of the Child’s participation in TEXAS ALLSTAR CHEER activities, or otherwise, and regardless of any negligence on the part of TEXAS ALLSTAR CHEER.

I/we further authorize a representative of TEXAS ALLSTAR CHEER to consent to medical treatment of the Child in the event of an emergency while at or away from the training facility. I/we give permission for TEXAS ALLSTAR CHEER to give my/our Child first aid and to arrange for transportation to a hospital and receive emergency medical treatment. I/we will assume all costs for such medical care. PLEASE NOTE – TAC IS NOT LICENSED BY THE STATE OF TEXAS AS A CHILD CARE FACILITY.

Today's date: May 8, 2024

First Participant's/Adult Name

First Name*

Last Name*

Phone*
First Participant's/Adult Age Acknowledgment*
First Participant's/Adult Date of Birth*
I certify that I am 18 years of age or older
First Participant's/Adult Information

Phone:

Child’s Doctor:

Health Insurance Company:

Policy Number:

Medication Currently Taking:

Allergies to medicines:

Further medical information or psychological disabilities:
First Participant's/Adult Signature*
Second Participant's/Adult Name

First Name*

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

Phone:

Child’s Doctor:

Health Insurance Company:

Policy Number:

Medication Currently Taking:

Allergies to medicines:

Further medical information or psychological disabilities:
Third Participant's/Adult Name

First Name*

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

Phone:

Child’s Doctor:

Health Insurance Company:

Policy Number:

Medication Currently Taking:

Allergies to medicines:

Further medical information or psychological disabilities:
Fourth Participant's/Adult Name

First Name*

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

Phone:

Child’s Doctor:

Health Insurance Company:

Policy Number:

Medication Currently Taking:

Allergies to medicines:

Further medical information or psychological disabilities:
Fifth Participant's/Adult Name

First Name*

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

Phone:

Child’s Doctor:

Health Insurance Company:

Policy Number:

Medication Currently Taking:

Allergies to medicines:

Further medical information or psychological disabilities:
Sixth Participant's/Adult Name

First Name*

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

Phone:

Child’s Doctor:

Health Insurance Company:

Policy Number:

Medication Currently Taking:

Allergies to medicines:

Further medical information or psychological disabilities:
Seventh Participant's/Adult Name

First Name*

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

Phone:

Child’s Doctor:

Health Insurance Company:

Policy Number:

Medication Currently Taking:

Allergies to medicines:

Further medical information or psychological disabilities:
Eighth Participant's/Adult Name

First Name*

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

Phone:

Child’s Doctor:

Health Insurance Company:

Policy Number:

Medication Currently Taking:

Allergies to medicines:

Further medical information or psychological disabilities:
Ninth Participant's/Adult Name

First Name*

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

Phone:

Child’s Doctor:

Health Insurance Company:

Policy Number:

Medication Currently Taking:

Allergies to medicines:

Further medical information or psychological disabilities:
Tenth Participant's/Adult Name

First Name*

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

Phone:

Child’s Doctor:

Health Insurance Company:

Policy Number:

Medication Currently Taking:

Allergies to medicines:

Further medical information or psychological disabilities:
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Participant's/Adult 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

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
Additional Parent/Guardian Information

Mother/Father’s Name:

Home Phone:

Cell Phone:

Address:

Email:

Employer:

Work Phone:

Address:

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.

I certify that my Child is mentally and physically capable of participating in any activity for his or her Cheer Squad conducted in conjunction with or by Texas Allstar Cheer.

I am the legal parent/guardian of the Child.



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*

Last Name*

Relationship*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Phone:

Child’s Doctor:

Health Insurance Company:

Policy Number:

Medication Currently Taking:

Allergies to medicines:

Further medical information or psychological disabilities:
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.


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