Hiram Hornets Youth Cheerleading 2024 Registration Form (Mini Hornets 3rd-5th grade, Baby Buzz K-2nd grade) Cheerleader InformationCheerleader's Name* First Last Birthdate* Month Day Year Current Age* What grade will your child be in when school starts again in August?*Choose GradeKindergarten1st2nd3rd4th5thCurrent Grade Level*Choose GradePre-KKindergarten1st2nd3rd4th5thPants Size*Choose SizeYouth XSYouth SYouth MYouth LAdult SAdult MAdult LAdult XLShort Size*Choose SizeYouth XSYouth SYouth MYouth LAdult SAdult MAdult LAdult XLParent / Guardian InformationMother's (Guardian) Name First Last Home PhoneMother's CellMother's Work PhoneMother's (Guardian) Email* Enter Email Confirm Email Father's (Guardian) Name First Last Father's CellFather's Work PhoneFather's (Guardian) Email* Enter Email Confirm Email Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact's Name* First Last Phone*Family Insurance Covers Injuries Incurred by Youth Sports* YES NO Insurance Company Name Insurance Policy Number PERMISSION MEDICAL RELEASE & WAIVER OF TRANSPORTATION LIABILITY I hereby certify that I have knowledge of my child’s physical condition and state of health, and I give my consent and permission for my daughter to engage in the active sports program of NWGYFL and the Hiram Hornets Youth Cheer Program. I do further certify that my daughter has no physical defects, disease, or disability that will in any way jeopardize his health of physical condition if he is allowed to take an active part in the program. I further state that I shall not hold any Person, Firm, or Corporation backing any team, nor any of the Coaches of the Hiram Hornets Youth Cheerleading Program, the Gold Bow Booster Club officers, the NWGYFL, and the Hiram High School Cheerleading Program responsible nor liable for injuries incurred during practice sessions, practice games, regularly scheduled games, or transportation to and from games. I further certify that by placing my signature on this document I have given permission to the Hiram Hornets Youth Cheerleading Program to transport my child to a medical facility to secure treatment if deemed necessary at that time. Parent / Legal Guardian Acceptance* I agree to the above terms and conditions Date* Month Day Year Parent / Legal Guardian's SignatureAUTHORIZATION FOR TREATMENT I hereby give permission for the representation of the Hiram Hornets Youth Cheerleading Program to secure immediate medical treatment for my child listed in this registration, who is under the age of eighteen (18) years. I further give my permission for a medical facility or a representative of the Hiram Hornets Youth Cheerleading Program to provide immediate medical treatment for the above listed child. I understand that medical treatment is authorized in my absence, and that my signature below releases the Medical Facility and the Hiram Hornets Youth Cheerleading Program and Hiram High School from liability regarding treatment if I cannot be reached. I further understand that I will be considered the responsible party for any charges incurred.Parent / Legal Guardian Acceptance* I agree to the above terms and conditions Date* Month Day Year Parent / Legal Guardian's SignaturePlease list below any existing medical conditions, allergies and prescription drugs taken:Payment Center No refunds will be granted. All school issued items are to be returned in clean, satisfactory condition at the end of the season. Registration First Payment: $125 Parent / Legal Guardian Acceptance* I agree to the above terms and conditions Registration Fee*Due Now $125.00Payment Information You can pay for your Registration with PayPal. You do not need to have a Pay Pal account to pay for registration. Total Payment $0.00
