BYC REGISTRATION Form

UpdatedWednesday May 19, 2021 byJAMIE WIELAND.

Branford Youth Cheer 2021

YOUTH CHEERLEADING  REGISTRATION  FORM

 

 

Participant’s Name ______________________________________________________________________________________________________________

 

Address ___________________________________________________________________________________________________________________________

 

Date of birth _________________________Age (as of July 31st, 2021) ___________ School grade as of Sept 2021_______________

 

City Branford State CT     Zip 06405           Check here____for sideline cheer registration

 

Parent/Legal Guardian’s Name ________________________________________________________________________________________________

 

Home Phone ____________________________ Cell Phone __________________________ Work Phone ______________________________

 

E­mail Address ___________________________________________________________________________________________________________________

 

 

 

 

Contact # 1

 

*PLEASE NOTE: sideline cheer is ineligible for competitions*

IN CASE OF EMERGENCY

Contact # 2

 

Name _______________________________________________________

 

Address      ____________________________________________________

 

Name ________________________________________________________

 

Address      ____________________________________________________

 

 

 

Home #

 

___________________________________________________

 

Home #

 

___________________________________________________

 

 

Cell # ______________________ Work # _______________________ Cell # _____________________ Work # ___________________________

**************************************************************************************************************** Participant’s Allergies: _____________________________________________________________________________________________________________ Participant’s Medical Conditions: ________________________________________________________________________________________________ MEDICATIONS CANNOT BE GIVEN TO ANY CHILD WITHOUT THE EXPRESS CONSENT OF THE PARENT/GUARDIAN IDENTIFIED ON THIS DOCUMENT OR BY THE CHILD'S PHYSICIAN IDENTIFIED BELOW.

Name of Participant’s Physician _________________________________________________ Phone________________________________________

 

******************************************************************************************************** WAIVER OF LIABILITY RELEASE FORM

I am aware of the nature of this activity and I hereby assume responsibility for _________________________________________________

(Participant’s Name)

to participate and to be photographed for publicity purposes. I will not hold the TOWN OF BRANFORD, CT, THE DEPARTMENT OF PARKS AND RECREATION and/or its employees responsible in the case of accident or injury as a result of this participation. I understand that this completed form must be in the possession of the Town of Branford, CT, Department of Parks and Recreation prior to participation in this program.

 

 
 


Parent/Legal Guardian Signature __________________________________________________________________ Date___

2021 Reg Form.docx