Bulls Jr. Cheerleaders

The Chicago Junior Luvabulls Are Seeking New Members! Come join us & perform at home games on the court at the and perform all throughout the Chicagoland area. All girls ages 7 - 17 are invited to join our team. The Chicago Junior Luvabulls program goals include: • Building Self-Confidence • Building Self-Esteem • Developing Teamwork Skills No auditions or tryouts! Space is limited! Register to reserve your space for the 2012-13 season (season runs from October 2012 - April 2013). The registration form can be downloaded by going to Bulls.com/JrLuvabulls; please complete and e-mail to [email protected]. The completed form can also be mailed to: C.C. Company of , Inc., P.O. Box 4712, Wheaton, IL 60189-4712. Confirmation will be provided via e-mail.

Registration fee of $155 (please note change) includes registration costs, training camp, pom pons and a Junior Luvabulls t-shirt. Please note that tickets are NOT included in this REGISTRATION FEE. A separate order form to order game tickets will be available at the parent orientation meeting on Sept. 29, 2012 at UIC Flames Athletic Building, 839 W. Roosevelt Rd., Chicago, IL 60608. Monthly tuition is $65. The Jr. Luvabulls uniform cost is at least $130 plus tax (please note change). Training Camp is on Sept. 29 at UIC Flames Athletic Building, 839 W. Roosevelt Rd., Chicago, IL 60608. PARENTS ARE REQUIRED TO ACCOMPANY THEIR CHILD TO REGISTRATION AND ATTEND PARENT ORIENTATION.

Something new for returning Junior Luvabulls only: returning Juniors must purchase a new top only, for a fee of $70.00. The full registration fee is due before parent orientation on Sept. 29. There are NO refunds or tuition breaks if you cannot attend the clinic on Sept. 29. (Possible facility sites: Chicago-UIC College Prep, 1231 S. Damen; Naperville-River Run Club, 4204 Clearwater Lane). For more information, visit Bulls.com/JrLuvabulls or Call C.C. Company of Illinois, Inc. or call (630) 668-8115

Participant Name: Date of Birth: Age:

Address: City: State: ZIP:

Contact Person: Facility Preference : (choose one from selection above)

Home Phone: Work Phone: E-mail Address:

Choose Only One: Adult T-Shirt Size: S M L XL Youth T-Shirt Size: S M L (New or Returning)

Payment Method: Credit Card: Visa MasterCard American Express (No Debit Cards Accepted) [$155.00] (No personal checks please; cashier’s checks or money orders only.)

Credit Card Number: Exp. Date: V-Code: (Required-last 3 digits on signature strip on back of card) Agreement of Compliance Medical Treatment, Liability Release, and Appearance Agreement

Advisor/Coach/Director: An Agreement of Compliance must be completed by each participant and signed by a parent or guardian in order for the individual to participate at a Junior Luvabull event. Please photocopy and retain for your records.

Participant’s Name______Grade______Age______

Date of Birth______Social Security Number______

Event Attending______Event Dates______

Organization Affiliation______

Medical History of Participant - Please provide details for all that apply. Allergies______High Blood Pressure______Asthma______Recurring sore throat/ear infection______Convulsions______Medications currently taking______Diabetes______Pre-existing injury currently being treated______Migraine headaches______Medical conditions currently under treatment______Heart trouble______Abnormal/irregular menstrual cycle______Contact lenses______Epilepsy/fainting spells______Mental disorders______Other______Daily medication and schedule______

I, ______(parent or guardian) understand that ______(participant) must be in compliance with C.C. Company of Illinois, Inc. regulations to perform/participate in the above mentioned event. I also understand that any violation of this agreement may result in the removal/disqualification of the team(s) or individuals involved. Regulations Parent/Guardian/Advisor/Coach/Director: The following release must be signed by each participant’s parent or guardian. A. I understand that by taking part in the above mentioned C.C. Company of Illinois, Inc. event, there is the possibility of injury or sickness to my daughter/son. I do hereby grant permission to hospital staff members to administer immediate treatment to my child should he/she be injured. B. I understand and agreed that by signing this waiver and acknowledgment, I am releasing and discharging C.C. Company of Illinois, Inc., the owners of the United Center, Chicago Professional Sports Limited Partnership (the “Bulls”), Chicago Bulls Limited Partnership, CBLS Corp., and all of their respective officers, agents, directors, employees, partners, shareholders, and representatives, and any and all of their respective subsidiaries or affiliates, the event facility, other individuals involved in the event and the official hotels from any and all claims, demands, or causes of action that hereinafter may accrue against them and that in any way may arise as a result of my daughter’s/son’s participation in the above mentioned event, regardless of whether such claims, demands, or causes of action are based on fault or negligence or not. C. I give C.C. Company of Illinois, Inc. the right and permission to film, photograph, or video tape my daughter/son for any reproductions associated or in any way connected with said televised or filmed event; in particular, reproduction for use in any form of advertisement for C.C. Company of Illinois, Inc. promotional purposes.

Insurance Carrier______Policy Number______Phone Number______

Parent’s Name______Address______

City______State______Zip______

Home Telephone______Work Telephone______

Parent’s Signature______Date______