Cheer Registration and Waiver Form - Georgia State University ...

2012 GEORGIA STATE UNIVERSITY CHEER AND DANCE COLLEGE PREP CLINIC REGISTRATION
(PLEASE PRINT YOUR INFORMATION LEGIBLY)
NAME _____________________________________ GENDER (CIRCLE ONE) M
F
CELL NUMBER ________________________________________________________
EMAIL ADDRESS ______________________________________________________
AGE _____________________ DATE OF BIRTH _____________________________
SCHOOL CURRENTLY ATTENDING ________________________________________
GRADE OR CLASSIFICATION (CIRCLE ONE)
FR SOPHO JUN SEN GSU PANTHER ID # (If currently on campus.)___________________
TEAM THAT YOU ARE INTERESTED IN (Please circle all that apply.)
ALL GIRL CHEER CO ED CHEER PANTHERETTES DANCE TEAM
CHEER POSITION: CIRCLE ALL THAT APPLY.
ALL GIRL BASE ALL GIRL BACK BASE ALL GIRL TOP COED MALE COED TOP GIRL
T SHIRT SIZE (CIRCLE ONE) Y LARGE SMALL MEDIUM LARGE X LARGE XX LARGE
CHEERLEADING OR DANCE EXPERIENCE:
WAIVER OF RESPONSIBILITY
I _______________________, will be participating in the Georgia State University College Prep Clinic
held on January 28 th , 2012 and March 24, 2012. I understand that while participating in this event, I will
hold harmless the Georgia State Athletics department, Athletic Association, it’s staff, and any other
participants in the event of injury or accidental death while participating in the event.
SIGNATURE OF THE PARTICIPANT _________________________________________________________
PARENT OR GUARDIAN (If participant is under 18) ____________________________________________
DATE _____________________________________
*THIS FORM MUST BE ACCOMPANIED BY A $50 MONEY ORDER WRITTEN TO GSU ATHLETICS.
MAILED TO: GSU Athletics c/o Darryl Lyons, 125 Decatur Street Suite 201, Atlanta GA30303