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Too Busy to Browse
Cheerleading
Tumbling Classes
Waiver
Member Portal
Menu
Private Lessons
Open Gym
Camps & Clinics
Birthday Parties
Gym Rental
Custom Music & Choreography
Job Postings
Blog
Our Staff
NEW MEMBER SPECIAL
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Waiver
Waiver
Waiver
Waiver and Release of Liability and Hold Harmless Agreement
Parent/Guardian Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Address
(Required)
Street Address
City
State
ZIP / Postal Code
Participant's Name
(Required)
First
Last
Participant's Date Of Birth
(Required)
MM slash DD slash YYYY
Participant's Age
(Required)
Health Insurance Company
(Required)
Member Number
(Required)
Please List Any Medical Problems Or Known Allergies
Medical Treatment Authorization/ Liability and Appearance Release
(Required)
I understand that there are risks of physical injury (including but not limited to cuts, sprains, broken bones and/ or catastrophic injury) associated with the activities taking place at this training center. In recognition of this acknowledged risk of injury, I knowingly and voluntarily waive all rights and or causes of action of any kind, including but limited to any and all claims of negligence, arising as a result of such activity from which liability could accrue to Starstruck Cheer and Dance, its owners, directors, instructors, managers, employees, substantiates, coaches, volunteers and affiliated parties (hereinafter referred to as Starstruck Cheer and Dance)
Medical Treatment Authorization/ Liability and Appearance Release
(Required)
I hereby agree to release Starstruck Cheer and Dance and hold them harmless of all liability and acknowledge that I knowingly and voluntarily assume full responsibility for all risks and injury that may take place out of active participation in this program and its practices and events on behalf of the participant.
Medical Treatment Authorization/ Liability and Appearance Release
(Required)
I am aware that this is a release of liability and acknowledgment of my voluntary and knowing assumption of risk of injury. I have signed this document voluntarily and of my own free will in exchange for the privilege of participation.
Medical Treatment Authorization/ Liability and Appearance Release
(Required)
I understand that the Starstruck Cheer and Dance produces promotional material about their program. I understand that the participant may be included in videotape and or photography within this program. I hereby grant Starstruck Cheer and Dance, its managers, owners, directors, coaches, successors, assignees, licensees, sponsors, and commercial exhibitions to exclusive right to photograph and videotape my student and further utilize the participant’s name, face, likeness, voice and appearance as part of this program’s advertising and promotion without reservation and or limitation. In granting this license I understand that Starstruck Cheer and Dance is under no obligation to exercise any of these rights, licenses, and privileges herein granted.
Medical Treatment Authorization/ Liability and Appearance Release
(Required)
I, parent and or legal guardian signed this document releasing Starstruck Cheer and Dance from any such liability described above and has acknowledged that I am knowingly and voluntarily assuming all risk of injury inherent to this program and its activities and or events.
The above named student has my permission to participate and attend the practices and events of the Starstruck Cheer and Dance Program. I warrant the
above information is complete and correct. I also warrant that if any changes are made to my information, I will contact the staff to update my information. I
have completely read and understand the above release information. I hereby authorize the Starstruck Cheer and Dance class instructor, director, owner, or
their agent to act in my behalf to provide emergency medical treatment. I further release the Starstruck Cheer and Dance program of all liabilities associated
with my child’s attendance to any practice, event or competition.
Guardian Signature
(Required)
