DO YOU HAVE RAIDER PRIDE? Archbishop Rummel High School ...

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Open Practices (4pm to 6pm) Tuesday, April 3, 2012 and Monday, April 9 , 2012 Tryout Clinic (4pm to 6pm) Monday, April 16, 2012 and Tuesday, April 17, 2012 Tryout (4pm) Friday, April 20, 2012 You must attend clinics to tryout. Information packet will be distributed at the first clinic. For more information, please email: kcusachs@rummelraiders.com
Archbishop Rummel High School 2012/2013 Cheerleader Tryouts Medical Release For Emergency Purposes Only Name: (Other than parent) _________________________________________________________________________________ Relationship to Camper: _______________________________________ Phone: _____________________________________ Family Physician: __________________________________________________________________________________________ Physician Phone: ________________________________________ Physician Address: _________________________________________________________________________________________ Insurance Company: _______________________________________________________________________________________ Primary: ____________________________________________ Policy Number: ______________________________________ Hospital: _________________________________________________________________________________________________ Allergies or Comments: _____________________________________________________________________________________ _________________________________________________________________________________________________________ Parental Consent: I hereby give written permission for my child to attend the 2012/2013 Cheerleader Tryouts at Archbishop Rummel High School. As a parent/guardian, I do hereby authorize the treatment by a qualified and licensed medical doctor in an emergency which, in the opinion of the attending physician, may endanger his/her life, cause disfigurements, physical impairment or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to contact me. Allowing a student to participate in the 2012/2013 Archbishop Rummel Cheerleading Tryouts constitutes the consent of his/her parents or guardians for the student’s name, voice or likeness to be used in news publications, audio-visuals, and other electronic transmissions including the Archbishop Rummel website. Parent’s Signature Date Please bring completed medical release to either your first open practice or tryout clinic in order to participate in the 2012/2013 Archbishop Rummel Cheerleading Tryout Session.
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DO YOU HAVE RAIDER PRIDE? Archbishop Rummel High School ...

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