Name of Cheerleader *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Parent Name *

First Name

Last Name

Phone Number *

(###)

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Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

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How did you hear about our clinic?

Poster/Flyer

Instagram

High School Marquee

Web Page Banner

Friend/Family

Acknowledgment *

CAPISTRANO UNIFIED SCHOOL DISTRICT DANCE/CHEER WAIVER AND RELEASE OF LIABILITY (Hereinafter "Student") and Student's parents ("Parents/Guardians") acknowledge and agree that they must assess the risks involved in the participation in competitive cheerleading and make the choice to participate in spite of potential risk of serious, catastrophic, and perhaps fatal consequences. Student and Parents/Guardians acknowledge and agree that no amount of instruction, precaution or supervision will totally eliminate the risk of injury or of adverse medical consequences to Student. Participation in cheerleading is inherently dangerous and may be severely impacted by Student's existing medical conditions. By granting permission to Student to participate in cheerleading competition, Parents/Guardians acknowledge that playing or practicing cheerleading can be a dangerous activity involving many risks of injury. Both the Student and Parents/Guardians understand and agree that the dangers and risk of playing or practicing to play include, but are not limited to, death, complete or partial paralysis, brain damage, serious injury to virtually all internal organs, bones, joints, ligaments, muscles, tendons and other aspects of the skeletal system, and the potential impairment of other aspects of the body, general health and well-being. Student and Parents/Guardians acknowledge and agree that they have been warned and cautioned against to the participation of Student in such activities. Nevertheless, in order to facilitate participation of Student in such activity, Student and Parents/Guardians, agree that if Student does engage in school sponsored athletic activity including, without limitation, practice, conditioning, cheerleading competition, games, or use of school facilities, Student and Parents/Guardians do so at their own risk. Student and Parents/Guardians agree that Student is voluntarily participating in these activities and using school facilities and premises and assumes all risk of injury, illness, damage or loss that might result, including, without limitation, injury, illness, or death. Student and Parents/Guardians agree on behalf of themselves (and their personal representatives, heirs, executors, administrators, agents and assigns (collectively "CUSD")) to release and discharge the Capistrano Unified School District, its employees, agents, representatives, coaches, assistant coaches, officials, successors and assigns, from any and all claims or causes of action (known or unknown) arising out of participation of Student in such activities and/or the negligence of CUSD. This Waiver and Release of Liability includes, without limitation, injuries which may occur as a result of Student's participation in any of the activities associated with athletic competition in practice or negligent instruction or supervision of Student.

I acknowledge that I have completely read this Waiver and Release and fully understand that it is a release of liability. I am waiving any right to bring legal action or assert a claim against CUSD by reason of the participation of Student in athletic activities.

Photo Release *

I acknowledge by registering for this event that I agree to allow the use of photos in social media and print advertising for the event

Refund Policy *

I acknowledge that refunds will be provided until June 15th (minus a 5% processing fee), but no refunds starting June 16th

Payment in full *

I agree to submitting payment in full. I understand that clicking submit will guide me to a payment page on which I am required to pay in full within one hour or my registration will be removed.

Signature *

First Name

Last Name

Date *

MM

DD

YYYY