Motions, Stunts, and Jumps Registration Form

Motions, Stunts, and Jumps Registration Form
Cheerleader Information
Cheerleader Name

First NameLast Name
Does child have registering sibling?
Sibling names and ages
Age
Date of Birth

MonthDayYear
Date
Gender
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Prior Cheer Experience

New cheerleader (No Experience)Beginner (1yr or less)Intermediate (2-3yrs)Experienced (3+ years)
Prior Cheer Experience Type
T-shirt size

Parent/Guardian Details
Parent/Guardian Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical Information
Please let us know if you have any allergies, existing illnesses or any medical conditions.
Are you currently taking any medication? If yes, please provide the generic name and its purpose?
Emergency Contact Details

If parent/guardian cannot be reached.
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number

Acknowledgment, Authorization, and Waiver
This cheerleader has my authorization to engage in the activities of the Motions, Stunts, and Jumps cheer program.

I allow taking photography of this camper that can be used for Motions, Stunts, and Jumps cheer program portfolio or advertising.

I authorized Motions, Stunts, and Jumps cheer program to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if they are unable to contact the parent/guardian. I allow them to apply first aid, medical or surgical diagnosis and treatment as necessary.

I allow Motions, Stunts, and Jumps cheer program to provide or administer the medication or supervise in self-administration.

I release Motions, Stunts, and Jumps cheer program and any of its coaches, staff, and manager for any responsibility in case of accident, illness, or injury during this cheerleader's enrollment.
Date Signed

MonthDayYear
Date
Motions, Stunts, and Jumps Cheer Prep Academy
218 Bingham St., Greensboro, NC27401
336-558-8407 - msj.cpa@yahoo.com - tinyurl.com/cheerprepacademy
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Cheerleader Information

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