Registration
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Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
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- denotes required fields
Family Information
First Name:
*
Last Name:
*
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:
*
State:
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AK
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DC
DE
FL
GA
HI
IA
ID
IL
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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:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Additional Information:
Assumption of Risk
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I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis, and even death, as well as damages and losses associated with participation in gymnastics activities and events. I further agree that Carolina Elite Inc. along with the employees. agents, officers, and directors of Carolina Elite Inc. shall not be liable for any losses or damages occurring as a result of participation in classes, camps events, competitions, or clinics. This acknowledgment of RISK AND MEMBERSHIP AGREEMENT has been read and is electronically signed voluntarily.
I've read the above and agree.
Release of Liability
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I hereby consent to my and/or my child's participation in the programs at Carolina Elite Inc. I understand that injuries can occur and risk is involved in any athletic activity for myself or my child, especially gymnastics and cheer activity that involves height and motion. I further agree that Carolina Elite Inc. along with the employees, agents, officers, and directors of Carolina Elite Inc., shall not be liable for any losses or damages occurring as a result of my and/or my child's participation in any activity offered by Carolina Elite Inc. including transportation to and from activities, except where such loss or damage is the result of the intentional or reckless conduct of one of the organizations or individuals identified above. This acknowledgment of WAIVER OF LIABILITY AND MEMBERSHIP AGREEMENT has been read and is electronically signed voluntarily.
I've read the above and agree.
COVID-19
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I am aware of the symptoms of COVID-19, which include but are not limited to fatigue, cough, fever, shortness of breath, runny nose, or sore throat. By my child's voluntary membership and participation in Carolina Elite Athletics, I am acknowledging that: Carolina Elite Athletics has encouraged me (and my child) to stay home if I (or my child) have any underlying medical conditions that could increase the severity of exposure to COVID-19 and me on behalf of myself and my child acknowledge that I am not aware of any underlying medical condition that could increase the severity of exposure to COVID-19 for myself or my child. Carolina Elite Athletics has encouraged me to wear a personal protective face mask while attending any Carolina Elite Athletics activities, and if I (or my child) choose to wear or bring my own personal protective face mask, the personal protective face mask will be properly cleaned and sanitized prior to entering Carolina Elite Athletics facilities. I understand that Carolina Elite Athletics is relying upon my honesty and Carolina Elite Athletics cannot be held liable for any exposure to the COVID-19 virus caused by any misinformation I have provided herein. ASSUMPTION OF RISKS I understand and I am aware that there are inherent risks and possible exposure dangers related to my child's membership and participation in Carolina Elite Athletics, including my own attendance at a Carolina Elite Athletics activity, in relation to the contagious nature of COVID-19. By signing this Agreement I on behalf of myself and my child ASSUME ALL RISK that I or my child may be exposed to or infected by COVID-19 by my child's membership and participation in Carolina Elite Athletics and that such exposure or infection may result in illness, personal injury, disability and/or death to myself or my child. I understand that my risk and my child's risk of becoming exposed to or infected by COVID-19 while participating in Carolina Elite Athletics may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Carolina Elite Athletics employees, contractors, staff members, members, invitees or guests. I on behalf of myself or my child voluntarily agree to ASSUME ALL RISKS, whether such risks are foreseen or unforeseen, general or specific, that arise from my child's membership and participation in Premier Cheer or are increased by the nature of mine or my child's pre-existing medical condition, and I accept sole responsibility for any illness or injury to myself or my child (including, but not limited to, personal injury, disability or death), damage, loss, claim, liability, or expense, of any kind, that I or my child may experience or incur in connection with my child's membership and participation in Carolina Elite Athletics (collectively, the "Claims").
I've read the above and agree.
Medical Readiness and Emergencies
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I certify that my child and all parental participants are in good health and physical condition and are fully able to participate in the programs offered by Carolina Elite Inc. including strenuous, physical sports. I hereby give my consent to Carolina Elite Inc. to provide, through a medical staff of its choice, customary medical/athletic training attention, transportation, and emergency medical services as warranted in the course of my/child's participation.
I've read the above and agree.
Photo/Video Release
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I hereby agree that Carolina Elite Inc., and its assigns, may photograph, video tape or record my dependent and use the film, videotape, audio recordings, or other media for the purposes of broadcast and/or cable television commercials and/or promotional presentations for Carolina Elite Inc. I agree to allow the finished presentation to be used for an unlimited amount of time and I understand and accept that I will receive no compensation for the use of my dependents likeness in any of the aforementioned applications. I hereby waive any right to inspect or approve the finished presentation. I also understand and accept that any such presentation or recording may be altered for future use as a separate presentation / commercial for Carolina Elite Inc. I agree that in order to cancel this photo/video release, I must come by the facility and fill out a Do Not Photo/Video form. I also understand that this form will remain on file only for the current session and a new form will need to be filled out for each following session. Carolina Elite Inc. will not release any names or other personal information with any presentation / commercial. You must answer Yes that you have read this - however, please add a note at the end of your registration to say "NO PHOTO please"
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
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Name as it appears on card:
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Nickname:
Card Expiration Month:
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Exp Year:
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Address Line 1:
Address Line 2:
City:
State:
AK
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AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
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Zip:
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