Raider Cheerleader Tryouts - Archbishop Rummel High School
Raider Cheerleader Tryouts - Archbishop Rummel High School
Raider Cheerleader Tryouts - Archbishop Rummel High School
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<strong>Archbishop</strong> <strong>Rummel</strong> <strong>High</strong> <strong>School</strong>2013/2014 <strong>Cheerleader</strong> <strong>Tryouts</strong>Medical ReleaseFor Emergency Purposes OnlyName: (Other than parent) _________________________________________________________________________________Relationship to Participant: _______________________________________ 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 2013/2014 <strong>Cheerleader</strong> <strong>Tryouts</strong> at <strong>Archbishop</strong><strong>Rummel</strong> <strong>High</strong> <strong>School</strong>. As a parent/guardian, I do hereby authorize the treatment by a qualified and licensed medical doctor in anemergency which, in the opinion of the attending physician, may endanger his/her life, cause disfigurements, physical impairment orundue 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 2013/2014 <strong>Archbishop</strong> <strong>Rummel</strong> Cheerleading <strong>Tryouts</strong> constitutes the consent of his/herparents or guardians for the student’s name, voice or likeness to be used in news publications, audio-visuals, and other electronictransmissions including the <strong>Archbishop</strong> <strong>Rummel</strong> website.Parent’s SignatureDatePlease bring completed medical release to either your first open practice or first day of tryouts in order toparticipate in the 2013/2014 <strong>Archbishop</strong> <strong>Rummel</strong> Cheerleading Tryout Session.