Registration
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To register for our half-year all-star cheer program at ECE Central (in Lancaster, MA), please complete the following information. This registration is for half-year TRYOUTS only. Program registration will be completed after athletes are placed on teams and additional documentation may be required.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
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- denotes required fields
Family Information
First Name:
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Last Name:
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Type
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Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
(Emails are kept confidential)
Address:
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City:
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State:
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Zip:
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Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
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Last Name:
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Student Gender:
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Female
Male
Birth Date:
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(format=mm/dd/yyyy)
Add New Student #2:
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Student's First Name:
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Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Questions/Options:
Do you give ECE Central permission to charge the $50 registration fee to the credit card below?
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Yes
No
Would you like to be considered for cross-teaming/double-teaming? (Please note- this does not guarantee a spot on multiple teams, it is only to gauge interest.)
Yes
No
Emergency Contact Name and Phone
Allergies or Medications?
Additional Information:
RELEASE & INDEMNITY
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I am aware that cheerleading and gymnastics are hazardous activities, and my child is voluntarily participating in this activity with my/our full knowledge of the danger involved and I hereby agree to accept any and all risks of property damage, personal injury or death. I hereby release Kimberly Gorman, ECE Central, Central Sports LLC and any of their instructors or agents from any present and future claims, including negligence for property damage, personal injury, or wrongful death, arising from my child's participation in cheerleading and gymnastics activities. Furthermore, I hereby voluntarily waive any and all claims, both presents and future, arising from my child's participation in cheerleading and gymnastics activities, including but not limited to negligence, property damage, personal injury, and wrongful death. I understand that cheerleading and gymnastics involve certain risks, including but not limited to, travel to and from the site of any future activity, physical contact and the possible reckless conduct of other participants. These risks also include but are not limited to death, serious neck and spinal injuries resulting in complete or partial paralysis, brain damage, and serious injury to virtually all bones, joints, muscles and internal organs. I further understand that cheerleading and gymnastics involves these risks despite the full attention of skilled instructors. I understand that I am responsible for my child before and after class. I take responsibility if I do not enter the building to drop off or pick up my child. I agree to hold harmless Kimberly Gorman, ECE Central, Central Sports LLC, its employees, volunteers and any agents from any claims or liability related to an accident or incident that may occur.
I've read the above and agree.
COVID 19- ASSUMPTION OF RISK
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The Coronavirus, Covid-19, has been declared a worldwide pandemic by the World Health Organization. Covid- 19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.
ECE Central ("ECE") has put in place preventative measures to reduce the spread of Covid-19, however, ECE cannot guarantee that you or your child(ren) will not become infected with Covid-19. Further, attending ECE could increase your risk and your child(ren)'s risk of contracting Covid-19.
By signing this agreement, I acknowledge the contagious nature of Covid-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by Covid-19 by attending ECE and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by Covid-19 at ECE may result from the actions, omissions, or negligence of myself and others, including, but not limited to ECE employees, volunteers, and program participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)'s attendance at ECE or participation in ECE programming ("Claims"). On my behalf, and on behalf of my children, I hereby release Kimberly Gorman, Central Sports LLC and ECE Central, and any of their instructors or agents from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of ECE, its employees, agents, and representatives, whether a Covid-19 infection occurs before, during, or after participation in any ECE program.
Athlete and Guardian agree to abide by the ECE Central Social Distancing Guidelines while participating in both indoor and outdoor activities on the premises of ECE Central.
I've read the above and agree.
MEDICAL ATTENTION
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I give ECE Central and its staff permission to transport my child to the nearest hospital in the event of an emergency. I further consent to medical treatment if necessary if the named parent/emergency contact cannot be reached.
I've read the above and agree.
PICTURE/NAME PERMISSION
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I agree to allow my child's picture, name and or likeness to appear in any ECE Central advertisements, websites and competition photographs, which may or may not be used for further social media/magazine/paper/lobby advertisements for ECE Central.
I've read the above and agree.
VIRTUAL INSTRUCTION
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By you or your child participating in any Virtual Practice, Workout or Video Submission:
1. You agree, represent, and warrant that:
-You are in a safe space, free of obstructions
-You are on a safe training surface
-You are wearing the proper attire to do the workout
-You are working out at your own risk, and if you feel uncomfortable doing any activity, you have the right to opt out
2. You further agree that the Release of Kimberly Gorman, ECE Central, Central Sports LLC and any of their instructors or agents that you previously agreed to shall extend and apply to this Virtual Practices and Workouts service, including but not limited to limitation of liability, indemnification, and assumption of risk.
3. In the event the participant is a minor, you, as the parent or legal guardian, agree to the above on behalf of yourself and your minor child. You further agree that you will observe and monitor your minor child during the course of the activity.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
Visa
Mastercard
Amex
Discover
Name as it appears on card:
Nickname:
Card Expiration Month:
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Address Line 1:
Address Line 2:
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Zip:
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