<p>2016-17 Elite All-Stars of Maine Cheer and Tumble Registration Form</p><p>PARTICIPANT CONTACT INFO </p><p>Child’s Name: ______Child’s Address: ______City/State/Zip: ______Child’s Home Phone: ______Child’s Cell: ______Child’s Email: ______Does your Child have Facebook: Yes No Date of Birth: ______Age as of August 31st 2016: ______Name of School: ______Grade in Fall 2016: ______How/where would you like to be contacted with urgent info?: ______Cheerleading Experience: ______Tumbling Experience: ______</p><p>PARENT CONTACT INFO </p><p>Mother’s Name: ______Father’s Name: ______Mother’s Home Email: ______Father’s Home Email: ______Mother’s Work Email: ______Father’s Work Email: ______Mother’s Home Phone: ______Father’s Home Phone: ______Mother’s Cell Phone: ______Father’s Cell Phone: ______Mother’s Work Phone: ______Father’s Work Phone: ______How/where would you like to be contacted with urgent info?: ______</p><p>MEDICAL INFORMATION & RELEASE</p><p>Emergency Contact Name (other than parents): ______Emergency Contact Phone: ______Emergency Alt. Phone: ______Medical Insurance Plan: ______Ins. Policy Number: ______Ins. Group Number: ______Dr.’s Name: ______Dr.’s Phone Number: ______Medical Conditions: ______Food Allergies: ______Medications Taken: ______</p><p>ACKNOWLEDGEMENT</p><p>I certify that my child has health, accident and liability insurance to cover bodily injury or property damage that may be caused or suffered while participating in this activity, or else I agree to bear the costs of such injury or damage to my child. I further certify that I am willing to assume and bear the costs of all risks that may arise or be created, directly or indirectly, through or my any such condition.</p><p>By signing this document, I acknowledge that if anyone is hurt during my participation or the participation of any of my children in this activity, I may be found by court of law to have waived my right to maintain a lawsuit against Elite All Stars of Maine on the basis of any claim from which I have released Elite All Stars of Maine by signing this agreement. By signing this, I acknowledge that Elite All Stars of Maine does not provide Medical Insurance.</p><p>Parent’s Signature: ______Date: ___/___/___</p>