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Chaos Elite CLINIC Registration Form
Participants will not be allowed to participate unless this signed document is received.

Chaos Elite Statement of Understanding: I hereby certify that I fully understand the following: 1. My daughter/son: _______________ will be involved in a variety of tumbling, motions, partner stunts, rotations and heights; therefore, participating in cheerleading and involves some amount of danger of personal injury. I totally assume the risks involved by participating at Chaos Elite. I further realize that improper conduct of cheerleading activity could result in catastrophic injury, paralysis or even death; therefore, I agree to abide by all U.S. All Star Federation (USASF) Safety Rules and Regulations. 2. I hereby certify that I have read, am thoroughly familiar with and will carefully abide by the USASF guidelines for safety in cheerleading. USASF Safety Rules and Regulations can be found at:http://usasf.net/safety/. 3. I further agree to hold harmless Chaos Elite gym, staff, and athletes for any injury, which I may incur by being a participant at Chaos Elite. STATEMENT: I have read carefully this memorandum, and I understand and accept the information and requirements contained in it.

I consent my approval for my child to have videos and photos taken.

STATEMENT: I have read carefully this memorandum, and I understand and accept the information and requirements contained in it.

Wednesday August 7th, 2019

Clinic Fee: $40 per athlete ($45 Non-Gym Member)

Payment Types Accepted: Venmo (@Luis-Ortega-36), Check, or Cash
Proof of payment will need to be shown on day of event.
Questions? Email Roxy@chaoselite.net
Email address *
Athlete Name: *
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Parent Name: *
Your answer
Date of Birth: *
Your answer
Parent Phone Number: *
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Email Address: *
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Emergency Contact *
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Emergency Contact Phone Number: *
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Medical Concerns and Medication
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Electronic Signature and Date (If under the age of eighteen years old a parent or guardian’s signature is required.): *
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