Name: Age as of start date:
Parent/Guardian Name:
Address:
City: State: Zip:
Phone (Day): Phone (Evening):
E-Mail:
Allergies:
Official T-Shirt:
Event Type Event Date
Payment Method Amount
Reminder, you need to mail your check or money order ASAP to 14233 W. 142nd Street. Your child's place in camp is not saved until the camp fee is received.
Where did you hear about "Lynn O'Brien Cheer & Dance?"
Special Instructions
Release Waiver: has my permission to participate in any/all of the Lynn O'Brien Cheer & Dance Camps, Clinics, or Classes. She is in good health and has no condition, which should prevent participation. It is agreed that neither Lynn O'Brien, nor any sponsors, nor its coaches or assistants, nor the location(s) or their associates assume and legal liability for injuries or other losses from participation in the camp. I understand when practicing & performing cheers and dances injury may occur from participation. I hereby give permission for my child's/camper's photograph/image or likeness to be used for promotional purposes.
Legal name of the Parent/Guardian Date By typing your name above you agree to the conditions "Release Waiver" and state that this form is filled out correctly to the best of your abilities.
Consent for Medical Treatment: As the parent/legal guardian of , I hereby give my consent for emergency mediacl care prescribed by a duly licensed doctor of medicine of dentistry. this car may be administered under whatever conditions are necessary to preserve his/her life, limb, or well being of my dependent.
Legal name of the Parent/Guardian Date By typing your name above you agree to the conditions for "Medical Treatment" and state that this form is filled out correctly to the best of your abilities.