LDA Cheer Team Registration Form & Waiver 2019/2020
Email address *
Student Name *
Your answer
Student Age *
Your answer
Student's Cell *
Your answer
Student Birthday *
Your answer
Student Address *
Your answer
Grade
Cheer Experience *
Required
Dance Experience
If you have cheered or danced before, please list where? (School, city and state)
Your answer
Can you flip? (Cartwheel, round off, walkover, back bend)Explain
Your answer
Can you do a front and back walkover?
Can you do jumps?
Can you do a leg stretch?
Can you do a Scorpion?
Address
Your answer
Parent Name
Your answer
Parent Cell
Your answer
Emergency Name, Cell, Relationship *
Your answer
Emergency Name, Cell and Relationship *
Your answer
Emergency Name, Cell and Relationship *
Your answer
Student Shirt Size
Student Short Size
Student Legging Size
Student Warm Up Size
Student Shoe Size
Your answer
Insurance Company
Your answer
Student Allergies
Your answer
Medical Conditions
Your answer
Policy Number
Your answer
Medical Conditions/Allergies
Your answer
I hereby agree to release LDA Cheer & Dance All Stars harmless of all liability, and herby acknowledge that I knowingly and voluntarily assume full responsibility for all risk of physical injury arising out of active participation in cheer and dance on behalf of the participate We have accept this risk and we further release LDA Cheer & Dance and its representatives from any claims for personal illness or injury that might sustain during participation in this activity. I have signed this document voluntarily and of my own free will in exchange for the privilege of participation.
I also give LDA Cheer & Dance permission to use my child’s picture in or on any form of advertisement for Lowery Divas Academy Cheer & Dance All Star affiliated event.
The Participant has my permission to participate in Lowery Divas Academy Cheer & Dance All Star events. I warrant the below information is complete and correct.
Parent/Guardian Digital Signature and Date
Your answer
A copy of your responses will be emailed to the address you provided.
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