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Rebels Elite SF

389 Oyster Point Blvd Suite 8F

South San Francisco, CA 94080

Treatment/Publicity/Liability Release

I authorize any licensed physician to render necessary emergency treatment for injury or serious illness when a parent cannot be reached. I will assume all financial responsibility for such treatment. I acknowledge that the above participant must have his/her own medical insurance. I understand that cheerleading camp, competitions, practices, clinics and gymnastics equipment have an inherent danger in participation, in spite of all precautions and accident preventatives, injuries do occur. I also acknowledge that each participant has elected to participate in Rebels Elite at their own risk and will not hold Rebels Elite employees and/or instructors liable for any and all injuries that may occur while participating in cheerleading. The undersigned does hereby grant Rebels Elite and its successors, the unrestricted right to use the undersigned’s name, likeness or appearance on any cheerleading or dance camp posters, calendars, photo content or medium to promote or market Rebels Elite. The undersigned does hereby expressly release and waive any demand, action, claim, license, royalty or other form of payment the undersigned and his or her agents, representatives or assigns may have based on claims of the undersigned as to rights of privacy, publicity, notoriety or any other rights arising out of or relating to any use of Rebels Elite of the undersigned’s name, likeness or appearance.

Medical Release Waiver

I certify that I am the parent or legal guardian for my child(ren). I hereby give my permission for any supervisor, coach or other team administrator associated with the Rebel Elite SF to seek and give appropriate medical attention for our child(ren) in the event of an accident, injury, illness. I will be responsible for any and all costs associated with any necessary medical attention and/or treatment. I hereby waive, release and forever discharge Rebel Elite SF from all rights and claims for damages, injury, loss to person or property which may be sustained or occur during participation in Rebel Elite SF activities, whether or not damages or loss is due to negligence. I hereby acknowledge that my children is (are) physically fit and capable of participation in all activities.

I Agree

June 27, 2022



First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Signature*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Signature*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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