The HEAT All Star Cheer & Stunt Club

1. The HEAT All Star Cheer & Stunt Club Summer Day Camp Registration Form (1 form per camper) Cost $125 non members $100 members Please check the camp(s) you will be attending: July 13th to 17th Aug 24th to 28th Paid by: chq_____________ or cash ______________or OAC_________ Total First name:__________________________________ Last name:_______________________________________________ Birthdate: (mmm/dd/yyyy)_____________________ age at time of camp _________boy/girl:__________ Home address:__________________________________City____________________Postal code________________ Home phone:________________________________Cell:________________________________________ Emergency contact:___________________________ Emergency phone:___________________________ Any previous cheerleading experience?_____________________________________________________________________ • In the event of a camper using unnecessary aggression or an unwillingness to use an appropriate code of conduct or not following the rules of the camp may be required to leave the camp without refund • The camp director and staff are not responsible for lost or stolen property • Campers are required to either bring a bag lunch and their own water bottles or money to buy lunch at the camp canteen each day • Campers must come prepared in approved camp clothing, cheer shoes or proper athletic runners, NO JEWELRY, hair back and away from face Camp Medical Information/Waiver Form Health Card #:______________________________________________________________ Doctor name:__________________________________ Phone #:_______________________________ Dentist name:_______________________________ Phone #:__________________________________ Please check any known medical conditions that the staff should be aware of: Allergies: Bee stings______ Penicillin______ Food ______ Other: ______________________________ Do you wear contact lenses______ Glasses ___________ Any conditions that will limit safe participation in any activity? I agree to having my child being photographed or videotaped for the purpose of putting it on our club website or promoting our club YES____ NO____ I, the undersigned parent or guardian do hereby grant permission for my son/daughter _________________________________ To attend The HEAT Cheer Camp. I acknowledge, understand and agree that in participating at the camp there is a possibility of physical injury/illness (both acute and permanent) and that my son/daughter is assuming risk of such injury/illness by his/her participation. I assume full responsibility for my son/daughter’s participation. In order that my son/daughter may receive the necessary medical treatment in the event of injury or illness, I hereby authorize The HEAT Cheer Camp Director and/or staff to seek medical treatment for my son/daughter for such illness or injury sustained during the camp. Furthermore, The HEAT Cheer Camp, the camp director or staff and the host facility will not be held responsible for any injury or illness incurred while my son/daughter is at the camp. Parent/Guardian name (please print)____________________________________ Parent/Guardian Signature:___________________________________________ Date:____________________________ IMPORTANT: You will not be considered registered for camp without this completed signed form WITH payment.