VEA Cheer Registration
2019-2020
Email address *
Athlete’s First Name *
Your answer
Middle Name *
Your answer
Last Name *
Your answer
Date of Birth *
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DD
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YYYY
Address, City, State & Zip *
Your answer
Mother/Guardian Full Name *
Your answer
Mother/Guardian Phone Number *
Your answer
Father/Guardian Full 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
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
Tumble Class Registration (you receive one free class a week with cheer tuition) if you choose multiple days you will be billed accordingly. If you need to schedule a make up class please call, text or message us for availability. If you are already enrolled in a tumble class and wish to change classes please check availability before switching classes. *
Required
T-Shirt Size *
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