Cheerleading Registration

CHEERLEADING REGISTRATION FORM

To register for Cheerleading, just fill out the short form below and click the "Submit" link.

First Name:*		Last Name:*
Street Address:*		Home Phone:
City:*	State:*	Zip:*

Gender: MaleFemale	Age:

Leagues:	Select Season:*	Practice Conflict: If any, which day(s) is a conflict for you?
		Mon.Tues.Wed.

Grade:*	School:	Church Home:


Parent / Guardian and Emergency Contact Information

Parent / Guardian Name:*	Phone Number:*	Email Address:*
Emergency Contact:*	Phone Number:*

Known Medical Conditions Please be as specific as necessary.

Buddy Link If your child wants to be assigned to the same team as one friend, they both need to name each other.


Volunteer Opportunities

I would like to be:	Full Name:	Coach Shirt Size:
Comments:

Release of Liability/Hold Harmless Agreement

The Parent or Legal Guardian, in consideration of the acceptance of their child as a participant in this activity sponsored by Westerville Christian Church (WCC), does hereby: 1. Agree to assume any and all risks and liabilities incidental to the child's participation; 2. Agree to indemnify, defend and hold WCC, its trustees, staff members, Elders, Coaches and officials harmless from and against any claim or demand, and from liability for any injury or property damage; 3. Acknowledge and understand that no medical insurance is maintained by WCC; such insurance being the sole responsibility of each participant family; and 4. Agree that all known medical/health conditions have been disclosed to the WCC on this form;
I AgreeI Do Not Agree


Student Information



Submit
* Required