Registration
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To register for our Fall Fundamentals program at ECE Central (in Lancaster, MA), please complete the following information. Registration is open until September 15th. Weekly practices will be held on Sundays from 10:30-12:00. Practices will begin on Sunday, September 15th and will continue through November 17th. Fees are all-inclusive of the 10-week program.
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:
*
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:
*
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:
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Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Questions/Options:
Athlete's age as of 6/1/2024
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Emergency Contact Name
Emergency Contact Phone Number
Allergies, Medications, or Medical Conditions?
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.
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.
Enter your Full Name:
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Other Questions/Comments:
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Name as it appears on card:
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Zip:
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