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Athlete Registration and Liability Form

1. I understand and acknowledge that the activity my child is about to engage in poses known risks
and unanticipated risks which could result in injury, paralysis, death, emotional distress, or damage to my child, or to property or to third parties. The following describes some, but not all of those risks:

Cheerleading, gymnastics, jumps and stunting entail certain risk, which simply cannot be
eliminated without jeopardizing the essential qualities of the activity. Without a certain degree
of risk, cheerleading, gymnastics, jumps and stunts would not improve their skills and the
enjoyment of the sport would be diminished.Cheerleading, gymnastics, jumps and stunting expose its
participants to usual risk of cuts, bruises and other more serious injuries as well. If your child
is injured, medical assistance may be required and will be at your own expense, not the
expense of Pinnacle Athletics or anyone associated with and/or working for Pinnacle Athletics.

2. I expressly agree and promise to accept and assume all of the risks in these activities. My child's
participation in this activity is purely voluntary. No one is forcing my child to participate, and we elect to
participate in spite of the known and unknown risks.

3. I hereby voluntarily release, forever discharge and agree to hold harmless and indemnify Pinnacle Athletics from
any and all liability, claims, demands, actions or right of action, which are related to, arise out of, or are in
any way connected with my child's participation in this activity, including those allegedly attributable
to the acts or omission of Pinnacle Athletics and staff.

4. Should Pinnacle Athletics or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce
this agreement, I agree to indemnify and reimburse them for any and all fees and costs incurred.

5. I certify that my child has health, accident and liability insurance to cover any bodily injury or property damage that may be caused or suffered while participating in this event and I agree to bear the costs associated with such injury or damage to my child. I further certify that my child have any medical condition which could interfere with my child's safety in this activity, and I am willing to assume and bear the cost of all risks that may be created, directly or indirectly, by any such condition.

6. In the event of an emergency necessitating medical attention, I hereby consent and give permission to Pinnacle Athletics and staff to make decisions and to perform such medical treatment upon my child relating to such injuries or medical condition which may be, in the sole discretion of Pinnacle Athletics, necessary
and proper under the circumstances.

7. Photos and Videos: In the event any pictures or videos are taken in the participation of any activity relating
to Pinnacle Athletics, I give the operator(s) and staff of Pinnacle Athletics the right and permission to use any such pictures or video in any form of advertisement, teaching opportunities related to all star cheer and/or for promotional purposes.

8. I agree to abide by all U.S. All Star Federation (USASF) Safety Rules and Regulations.

9. I hereby certify that I have read and abide by the USASF guidelines for safety in cheerleading.

10. USASF Safety Rules and Regulations can by found at: http://usasf.net/safety.

11. I have read this memorandum and I understand and accept this information contained in it.

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Email Address: *
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Athlete (Birth Name and Nickname) Name: *
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Athlete Date of Birth (Birth Certificate Required for Proof): *
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Athlete Current Age: *
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Gender: *
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Parent(s) Names: *
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Athlete Phone Number: *
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Parent Phone Number: *
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Address: *
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Emergency Contact: *
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Emergency Contact Phone Number: *
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Insurance Name: *
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Insurance Policy Number: *
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Medical Concerns: *
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Medications: *
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T-Shirt Size: *
Electronic Signature and Date (If under the age of eighteen years old a parent or guardian's signature is required): *
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