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LjC Mini Cheer Clinic

Each student must have medical coverage to participate. Any previous injuries must be cleared with coach. Participant Name _______________________________________ Age____________

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LjC Mini Cheer Clinic

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  1. Each student must have medical coverage to participate. Any previous injuries must be cleared with coach. • Participant Name_______________________________________ Age____________ • Parental signatures below affirm they will keep this policy in effect for the duration of the student’s participation. • It is to be understood that the Jr. Cheer Board and/or coaching staff is not liable for any medical, dental or hospital bill occurring as a result of cheerleading injuries incurred by a student while participating, and such bills, in excess of insurance benefits shall be the responsibility of the student’s parent(s) or guardian(s). • I authorize my child(ren)to participate in the cheerleading mini clinic, without a previous physician physical examination . I believe she/he is physically fit and able to participate. I realize that this activity involves a potential for injury, which is inherent in all sports. I further recognize that medical treatment on an emergency basis may be necessary at a time in which I may not be available to give my consent in advance. I acknowledge that I have read and understand this earning. • I have read and understand the medical responsibilities involved with cheerleading and are willing to abide by them.  • Parent/Guardian Signature Date • Number to call in case of emergency • T-shirt size _______ (toddler-adult xl are available, please specify child or adult) • * T-shirt is included if registered by May 12th. • Registration is complete when payment has been made and this Mini • Clinic Parent Release Form has been signed. • Checks can be sent to: Liberty Jr. Cheer, 21000 NW Quatama rd. #11 Beaverton, OR 97006. • Credit cards are excepted on our website with a 2.9% processing fee. • If you have any questions please feel free to contact Jodi Robinette (503)720-2903 or ljcdirector@yahoo.com • Thank-you and we look forward to working with your cheerleader(s). • Liberty Jr. Cheer cheerleader & Coaching Staff LjC Mini Cheer Clinic Registration & Medical Release Form Pre – K through 7th graders Thursday, May 19th 10:00am-12:00pm Lenox Elementary School - Gym $20, includes t-shirt*

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