Brookline Cheerleading Clinic Registration

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This form is required to register your K-8 athlete for the Youth Cheer Clinic hosted by the Brookline High School Cheerleading Program.

Wednesday March 6th

3:30-5:30pm

Brookline High School Tappan Gym #2 (66 Tappan St)

We will work on skills within each of the main aspects of cheerleading: stunting, tumbling, jumps, and cheer/dance. Athletes will be separated into age and skill appropriate groups that allow all participants to improve using skill progression while having fun!

If you are signing up more than one athlete to participate, please fill out a separate form for each child.

Cost: $25 per athlete

Payment Methods:

Check or Money Order made out to Brookline Cheerleading
CashApp $brooklinecheer write athlete's name in memo.

Email *

Athlete Name (First Name, Last Name) *

Athlete's Current Grade *

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Parent/Guardian/Caregiver First Name, Last Name *

Parent/Guardian/Caregiver Phone Number *

Parent/Guardian/Caregiver Email Address *

Emergency Contact Name & Relationship (Different than above) *

Emergency Contact Phone (Different than above) *

Parental Consent and Liability

NOTICE OF RISK:

My student athletes and I, the student’s parent/guardian understand that sports activities, including cheerleading, involve risk of injury. When an athlete practices, plays or participates in any sport, the activity can be dangerous. The student risks serious and permanent injury which may affect his/her well-being.

PARENTAL CONSENT, RELEASE FROM LIABILITY

I, the undersigned parent or guardian(s) of student named above, a minor, do hereby consent to his/her participation in voluntary athletic programs and do forever RELEASE, acquit, discharge, and covenant to hold harmless the Town of Brookline, BHS Coaches and BHS Cheerleaders of and from any and all actions, causes of action, claims, demands, damages, costs, loss of services, expenses and compensation on account of, or in any way growing out of, directly or indirectly, all known and unknown personal injuries or property damage which we/I may now or hereafter have as the parent or guardian of said minor, and also all claims or right of action for damages which said minor has or hereafter may acquire, either before or after he/she has reached his/her majority resulting or to result from his/her participation in this activity.

In case of medical emergency, I understand that every attempt will be made to contact parents or guardians. If they cannot be reached, I hereby give my permission to the physician selected by Brookline Cheerleading Clinic to secure medical treatment for my child. The person enrolling at the Brookline Cheerleading Clinic, parent or legal guardian assumes all risk of loss of property or injury to the person, including injuries resulting in caused cased by or incidental to dangers associated with cheerleading activities, agrees that there are certain inherent dangers related to cheerleading participation, and therefore agrees to hold Brookline Public Schools and the Brookline Cheerleading Clinic, its owners and employees faultless and specifically agrees not to make any claims against Brookline Public Schools and the Brookline Cheerleading Clinic for any injuries which would be considered to be from normal risks associated with participation in cheerleading activities.

A medical record of the enrolling athlete must accompany this registration, including but not limited to all precautions and conditions the camp directors should be aware of.

Parent/Guardian/Caregiver Signature & Date:

By typing my name as a digital signature, I/We acknowledge the inherent risk in my child’s participation in this activity and assume full responsibility for all injury that my child may sustain as a result of participation.

Health Insurance Company Name, Phone & Address *

Policy Holder's Name & Policy Holder Number *

Relevant Medical Record

Please list any existing health issues and considerations for clinic directors to be aware of.

I do/do not consent for my athlete to be photographed and posted on social media *

Yes, my athlete can be photographed and posted to social media

No, my athlete is not allowed to be photographed and posted to social media

How did you hear about our Youth Cheer Clinic?

Additional questions/notes to coaches

Send me a copy of my responses.

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