Unionville High School Cheerleading

    Mail or Drop off to:    Robyn Brazill, Cheerleading Coach
                           Chadds Ford Elementary School
                       3 Baltimore Pike
                   Chadds Ford, PA 19317

Registration should be received by June 8, 2011: Confirmation and reminder emails will be sent.

LIMITED Walk-In Registration Available

DON”T FORGET:
**Hair must be pulled back     **No jewelry     **No gum         **Sunscreen

**Bring a packed lunch         **Water jug clearly labeled with name.

If you have any questions, feel free to contact Robyn Brazill at rbrazill@ucfsd.org

9th ANNUAL CHEERLEADING & SPIRIT CLINIC
HOSTED BY THE UHS VARSITY CHEERLEADERS
Tuesday, July 19th & Wednesday, July 20th

Time: 10 am to 2 pm
Registration begins at 9:30 am
Where: Chadds Ford Elementary School Gym
Cost: $65 (non-refundable)

Name: _________________________________________ Grade as of Fall 2011:_________
Phone: _______________________ Address: _____________________________________
Email: _____________________________________________

Please return this completed and signed form to Attn: Robyn Brazill, Cheerleading Coach; Chadds Ford Elementary School, 3 Baltimore Pike, Chadds Ford, PA 19317. Please include your non- refundable registration fee of $65 payable to UHS Activities; Memo Cheer Clinic

UHS Cheerleading Spirit Clinic Medical and Liability Release:

_____________________ elects to take part in the UHS Cheerleading event, which is sponsored by the UHS Cheerleading squad. I/We understand that our son/daughter is required to be in good physical shape and condition and that the activities, which he/she will be asked and expected to participate in, are strenuous and require physical and athletic agility. I/We understand that cheerleading is an activity in which the risk of injury is high; that any one of the routines involving our son/daughter’s participation in cheerleading activities in general could lead to serious injury, including partial or total paralysis, even death. I/We have also discussed this with our child and among ourselves. Despite this understanding of the possibility of serious or catastrophic injury or death and the risks involved, we still consent to the participation in this activity by our son/daughter.

I/We represent to that, to the best of our knowledge and belief, our son/daughter has no physical, medical, or mental disability or other limitation that would restrict his/her ability to fully participate in this activity.

I/We agree to, and by the signing of the agreement, release the coaches, volunteers, staff of Unionville High School, and the Board of Education from any claim of negligence by ourselves, our son/daughter, our heirs, executors and assigns, from any liability arising from claims for damages for injury to our son/daughter and any claims for loss or damage to his/her property which may arise our of his/her participation in the Unionville High School Cheerleading Spirit Clinic of July 19th and 20, 2011.

I/We further acknowledge that the above individual is covered by health insurance the particulars of which are described below. I hereby agree that we are responsible for any required medical treatment, and give permission for my child to receive medical treatment in the event that I am unable to be contacted. In order that participant may receive necessary treatments, I hereby hold Unionville High School and their Cheerleaders, and coaches harmless in the exercise of this authority.

Name of Participant: ___________________________________________________________

D.O.B. ___________________________________ SS# (if required) _____________________

Address:_____________________________________________________________________

Parent Name: ______________________________________ Phone: ____________________

Alternate #: _______________________________________

Medical Insurance Carrier:_______________________________________________________

Address of Carrier: _____________________________________________________________

Policy Number: ____________________________________

Additional Insurance Info Required:________________________________________________

Emergency Contact Name and Phone: _____________________________________________

List any pre-existing conditions, allergies, medications, etc.:_____________________________

Parent/Guardian Signature: ___________________________________Date: ______________