Xtreme Heat All Stars - Season #11
2021-2022 Registration/Commitment Form Season #11
Email *
Athlete First Name *
Athlete Last Name *
Athlete Date of Birth *
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Names of Parent/Legal Guardian *
Primary Phone *
Secondary Phone
Address *
City *
Emergency Contact Name *
Emergency Contact Phone *
Health Insurance Company *
Policy Number *
Please list any serious injuries, surgeries or illnesses. *
Please list any medical conditions and allergies *
Please list any medications your child currently takes. *
Please list all tumbling skills that your child can do unassisted. *
Please list any experience your child has in stunting and what level (example level 1 flyer and level 2 main base) *
Would you like for your child to be considered for a crossover? (more than 1 team) *
It is possible for Junior and Senior Elite All-Star teams to win a bid to the D2 Summit at Disney World in May 2022. Would you like for your child to be considered for a D2 Summit Eligible Team? *
I have read the release of liability waiver and I understand the risks associated. I release Xtreme Heat All Star Cheer of all liabilities associated with participation. *
Required
I have read and understand the policies and expectations outlined in the 2021-2022 Xtreme Heat All-Star Cheer Policies. I understand that I am signing up for a full season of all star cheer. I understand that Xtreme Heat takes priority over any other activity I am involved in and that I will be fully committed to my team. I also understand that if I am unable to uphold my commitment that I will be charged a fee of $250 on top of the monthly fees. *
Required
Photo Release: I understand that photos/videos may be taken during practice, classes, competitions and other gym activities. I give my consent for them to be posted by Xtreme Heat's coaches to social media and website. *
Required
Full Name of person completing this form. By typing my name below, I am committing to the 2021-2022 season with Xtreme Heat All-Star Cheer. As the parent or legal guardian of the athlete I am registering, I am acknowledging that I fully understand the policies and expectations and I agree that I and my child will be fully committed for the entire cheer season (May 2021-May 2022). *
A copy of your responses will be emailed to the address you provided.
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