North East Athletic Center & WILD All-Stars Cheerleading Medical/Logo & Model Release Waiver
I give my approval for Athlete’s participation in any and all activities of the program. I hereby authorize Northeast Athletic Center and WILD All Stars program to treat my son/daughter for injuries or illness they may incur while participating in activities, tumbling, cheerleading etc. at Northeast Athletic Center and WILD All Stars. I authorize necessary treatment and admission for any hospitalization designated by Northeast Athletic Center and WILD All Stars or their designate. It is understood the parents or their agents will be called upon to give additional authorization if advanced treatments are necessary. I recognize the potential for injury and or even death which can occur in tumbling/ cheerleading/ competition/ camp type activity. I certify that my child has health, accident, and liability insurance to cover any bodily injury or property damage that may be caused by participating in this event or activity, or else I agree to bear the cost of such injury or damage to my child. I further certify that I am willing to assume the risk of any medical or physical condition my child may have or else I am willing to assume and bear the cost of all risks that may be created, directly or indirectly, by any such condition. I hereby consent myself and for the above named Athlete to participate in tumbling/cheerleading activity on equipment used by the cheerleading program at Northeast Athletic Center and WILD All Stars and do herby, for myself and the above named Athlete, waive and release any and all rights and claims for damages that I or the above namedAthlete may have at any time against the Northeast Athletic Center and WILD All Stars or any of its agents for any injury or damages in connection with my child’s association with tumbling/cheerleading competition and are not limited to and or any other activity associated with or sponsored by Northeast Athletic Center and WILD All Stars. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Northeast Athletic Center and WILD All Stars on the basis of any claim from which I have released the herein.
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LOGO & MODEL RELEASE

By signing, you are giving Northeast Athletic Center and WILD All Stars the right to use your child’s likeness in various published media. This includes newspapers, internet photos, phone, and the like. If you do not wish for your child’s photo to be published, you may indicate that on the signed contract. The Northeast Athletic Center and WILD All Stars name and logo are exclusively owned by Northeast Athletic Center and WILD All Stars Owners. Use of either the name or logo without written consent from the owner is prohibited. This includes but not limited to: email addresses, window stickers, yard signs, etc.
Email address *
Athlete's Name *
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Athlete's Birth Date *
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Athlete's Address
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Parent/Guardian's Name *
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Parent/Guardian's Phone # *
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Parent/Guardian's Email *
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Emergency Contact
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Emergency Contact Phone #
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Parent Agreement *
Today's Date *
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A copy of your responses will be emailed to the address you provided.
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