CHEER

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413 Branchway Road, Ste. E&F,

N. Chesterfield, VA 23236

Phone: (804) 594-0878

READ AND Fill out the following form to register FOR TUMBLING NOW!

Treatment Publicity Liability Release:

I authorize any licensed physician to render necessary emergency treatment for injury or serious illness when neither parent can be reached and will assume all financial responsibility for such treatment. I acknowledge that the above participant must have his\her own medical insurance. I understand that cheering camps, competitions, practices, clinics and gymnastics equipment have an inherent danger in participation and that in spite of all precautions and accident preventatives, accidents do occur. I further acknowledge that each participant has elected to participate in Cheer Challenge All-stars, Inc. at their own risk and will not hold Cheer Challenge All-stars, Inc., their employees, Branchway LLC, or any hired clinicians  or instructors liable in any way if an injury occurs. The undersigned does hereby grand Cheer Challenge All-stars, Inc and its successors, the unrestricted right to use the undersigned name, likeness, or appearance on any Cheer posters, calendars, photography, flyers, video material, websites, or similar promotional material to promote or market Cheer Challenge All-stars, Inc. The undersigned does hereby expressly release and waive any demand, action, claim, license, royalty, or other form of payment to the undersigned, and his or her agents, representatives or assigns, may have based on claims of the undersigned as to rights of privacy, publicity, notoriety or any other rights arising out of or relating to any use by Cheer Challenge All-stars, Inc. of the undersigned name, likeness, or appearance.

Tumbling Registration Form

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Phone: (804) 594-0878

Fax: (804) 594-0879

Email: cheerchallengeva@gmail.com

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