VEA Tumble Registration
2019-2020
Email address *
Athlete’s First Name *
Your answer
Athlete’s Preferred Name, If different than above
Your answer
Middle Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Address *
Your answer
Mother/Guardian Full Name *
Your answer
Mother/Guardian Phone Number *
Your answer
Father/Guardian Name *
Your answer
Father/Guardian Phone Number *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Insurance Provider
Your answer
Policy Number
Your answer
Current Medications
Your answer
Allergies
Your answer
How did you hear about us? If a referral from a friend, please let us know who! *
Your answer
Video & Photography Release: I understand that my child’s photograph/video may be taken during the course of class instruction or during a special event. I hereby grant my permission for the resulting photo/video to be used for any and all publicity and printing purposes. *
Medical Release: I understand that in any activity associated with Valley Elite cheer and tumble the potential exists for injury, including, without limitation to, sprains, broken bones, head injuries, paralyses, other serious injuries and even death. Valley Elite cheer and tumble and its employees shall not be responsible for losses and damages associated with participation in any activity, exhibition, competition, clinic or travel to or from any event in which the above named is involved. I hereby release Valley Elite cheer and tumble staff to render first aid in the event of any injury or illness, to seek medical assistance as deemed necessary and to transport to a medical facility or to call an ambulance. *
I understand that by typing my name in the box below the information on this form is true to the best of my ability and that this serves as my signature. *
Your answer
Please select the class/classes you would like to enroll in. (Please verify availability beforehand) If you need to schedule a make up class please call, text or messasge is for availability. You will be billed based on the number of classes chosen. *
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