Clinic Registration Form

(Print Form & Mail to BCWB, P.O. Box 3528, Frederick, Md 21705)

Parent Name   Parent Telephone     Parent Email Address         Cheerleader School Name    Cheerleader Grade      Cheerleader Experience     (Beginner, Intermediate, Advance)     Clinic Selection All Three (3) Clinics All $105.00 Tuesday, Date TBD Jumps/Motion $40.00 Wednesday, Date TBD  Stunts $40.00 Thursday, Date TBD  Routine/Choreography  $40.00

Total Payment Enclosed__________________

Medical Release & Registration Agreement  

The undersigned, parent/legal guardian of the player requesting league admittance, does hereby affirm that the applicant is in good health and suffers from no illness, disability, or condition that requires the taking of medication on regular basis unless that condition is disclosed and approved. Furthermore, the undersigned has no knowledge of any reason the applicant cannot participate in vigorous physical activity. The undersigned hereby expressly agrees to be responsible for any medical bills incurred in the treatment of any illness or accident. In the event of any such accident or injury, I hereby consent to allowing any of the league supervisors to procure any medical treatment deemed advisable on behalf of my child or ward without prior consent. I understand that, as a condition of admittance as a league participant, the undersigned, on behalf of all parents and guardians, and behalf of the applicant, hereby release Basketball Coaches Without Boundaries and all other employees or agents of the league from any and all liability in regards to injury or illness, either mental or physical suffered by the league participant during or related to the league by the person or entity against which the claim is made.   

I have read the above and agree to the Clinic conditions:   

 Parent Signature_______________________________     Date________