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Participant Information
Cheer Athletics Pensacola
380 Lurton Street; Pensacola, Fl 32505
Athlete First Name
Last Name
Date of Birth
Additional Athlete First Name
Last Name
Date of Birth
Household / Adult Primary Contact
Relationship to Participant:
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Self
Mother
Father
Guardian
Other
Other
First Name
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Last Name
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Phone Number
Email Address
Address
AutoPay
AutoPay is run on the schedule you choose: 1st of each month or Split pay on the 1st and 15th of each month. AutoPay is optional but highly encouraged. A $20 late fee is assessed each month to any unpaid accounts on the 16th of each month.
Name on Card
Credit Card Type
Visa
MasterCard
American Express
Discover
Credit Card Number
Expiration Date (mm/yy)
3 (or 4 for AMEX) digit code
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Participant Agreement, Release and Indemnification
I, the Participant, would like to participate in all the various physical activities conducted by Cheer Omega LLC and I understand that these activities present some risks. I understand the nature of this activity and that I am qualified, in good health, and in proper physical condition to participate in such activity. I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the activity. I fully understand that the activity involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or even by the negligence of the "releasees" identified below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, cost, and damages I incur as a result of my participation in the activity. I hereby release, discharge, and covenant not to sue Cheer Omega, LLC, its representative administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the activity takes place (each considered one of the "RELEASEES" herein) from all liability, claims, demands, losses, or damages, on my account caused or alleged to be caused whole or in part by the negligence of the "releases" or otherwise, including negligent rescue operations and further agree that if, despite the release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the releases, I will indemnify, save, or hold harmless each of the Releases from any loss, liability, damage, or cost, which may incur as a result of such claim. I also acknowledge that the owner and lessors of any property where I participate are not involved directly or indirectly with the oversight or conduct of Cheer Omega, LLC or its activities. I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance of this agreement, notwithstanding, shall continue in full force and effect.
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I have read and agree and accept the terms above
PARENTAL CONSENT AND I, the minor’s parent and/or legal guardian, understand the nature of the above referenced activities and the Minor’s experience and capabilities and believe the minor to be qualified to participate in this activity. I hereby Release, discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releases from all liability, claims, demands, losses or damages on the minor’s account caused or alleged to have been caused in whole or in part by the negligence of the Releases or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the above Releases, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releases from any litigation expenses, attorney fees, loss liability, damage, or cost any Release may incur as the result of any such claim.
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I have read and agree and accept the terms above
Printed name of Parent/Legal Guardian
(printing below means that you agree to the terms stated above and that all information is valid, current, and correct. Please update us immediately if any information changes)
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Date Signed
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