Magnitude Cheer Online Registration

Registration

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Teaching integrity and respect while increasing confidence and strength through athletics

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Parent Information

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

In case of emergency, who should we contact if the adults listed above are unavailable*

Health Insurance Carrier, Subscriber Name, and I.D. Number

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Previous Injuries

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor and Phone Number

Please note that student arriving more than 10 minutes late to their class may not be able to participate or asked to take an alternative class instead.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Previous Injuries

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor and Phone Number

Please note that student arriving more than 10 minutes late to their class may not be able to participate or asked to take an alternative class instead.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Previous Injuries

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor and Phone Number

Please note that student arriving more than 10 minutes late to their class may not be able to participate or asked to take an alternative class instead.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Previous Injuries

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor and Phone Number

Please note that student arriving more than 10 minutes late to their class may not be able to participate or asked to take an alternative class instead.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Previous Injuries

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor and Phone Number

Please note that student arriving more than 10 minutes late to their class may not be able to participate or asked to take an alternative class instead.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Release of Liability

I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis, and even death, as well as other damages and losses including negligence of "releases" named below, associated with participation in cheerleading activities and events, including, but not limited to, dance, gymnastics, tumbling, stunts, pyramids, and other types of movement. I agree that Magnitude Cheer and the sponsor of any Magnitude Cheer representatives, guest officials, spectators, and next of kin shall not be liable for any and all, including, but not limited to, death or damage to property or person(s), losses, or damages occurring as a result of myself/my child's participation in any event or activity. Any other representatives and I waive and release all rights and claims to sue for damages that my child or I may have against the staff or representatives of Magnitude Cheer and hereby agree to hold harmless Magnitude Cheer, its agents, employees, or servants, whether paid or volunteer, against any and all claims which may arise while participating at Magnitude Cheer. I HAVE READ THE RELEASE OF LIABILITY AND AM FULLY AWARE OF THE RISKS INVOLVED WITH PARTICIPATION IN ATHLETIC ACTIVITIES. BY SUBMITTING, I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS, AND AGREE TO THE ABOVE, WITHOUT EXCEPTION.

I do hereby allow the student listed above to fully participate in this program.

I've read the above and agree.

Consent to First Aid

I hereby give consent to the staff to render temporary first aid to myself/my child in the event of an injury or illness, and if necessary to seek appropriate medical attention.

I've read the above and agree.

Publicity Release

I give Magnitude Cheer permission to e-mail, photograph, videotape, and/or interview myself and/or my child(ren) for publicity purposes. I waive the right to inspect and/or approve the finished product.

I've read the above and agree.

Code of Conduct

I agree not to use foul language while on or around the premise. I will address any issues I may have with the staff, rather than venting in the parent room. My child will follow the gym rules: no gum, no food, water only, hair pulled up, as well as arrive early for class/practice. For Intro to Cheer classes, my child will wear socks and sneakers. I will be held financially responsible for any and all damage to any part of our facility, equipment, fixtures, outside property, or other member's personal property, that occurs as a result of any intentional, malicious, or aggressive behavior, or failure to abide by any of the rules of the facility.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

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