Participant Release and Waiver Form

Participant Details

Participant's Name*

Birth Date*

Home Phone

Address*

City*

State*

Zip*

Parent/Legal Guardian Details

Name*

Relationship to Minor

Parent Email Address*

Work/Cell Phone

Address

City

State

Zip

School Details

Participants School & Grade*

Phone

Address

City

State

Zip

Medical Details

Doctor's Name

Doctor's Phone

Dentist's Name

Dentist's Phone

In regard to the above mentioned person, check all that apply, and provide explanation.

Allergies to foods, medication, etc.*

High Blood Pressure*

Conditions currently under treatment*

Asthma*

Convulsions*

Medications currently taking*

Diabetes*

Epilepsy*

Migraine Headaches*

Heart Trouble*

Fainting Spells*

Pre-existing injury under treatment*

Contact Lenses*

Other*

Provide Explanation for Any Conditions

Daily Medication and Schedule:

Insurance Carrier*

Policy #

Primary Insured's Name*

Insurance Type*

Release and Waiver

I, as a parent or legal guardian of the aforemention participant, a minor (hereinafter “Minor”), hereby grant the permission necessary to allow the Minor to participate in the event (camp, competition, virtual event) to be sponsored by CheerTime Athletics/Dream Team Allstars. I acknowledge and agree, on my own behalf and on the behalf of the Minor, that such participation subjects the Minor to the possibility of physical illness or injury (minimal, serious, catastrophic and/or death) and that I, on my own behalf and on behalf of the Minor, acknowledge that the Minor is assuming the risk of such illness or injury by participating in the CheerTime Athletics/Dream Team Allstars sponsored event (camp, competition, virtual event). In the event of such illness or injury, I authorize CheerTime Athletics/Dream Team Allstars to obtain necessary medical treatment for the Minor and hereby, on my own behalf and on the behalf of the Minor, release and hold harmless CheerTime Athletics/Dream Team Allstars, the Hosting Site, on whose premises the Event will occur, (hereinafter the “Hosting Site”), its affiliates, the affiliates of CheerTime Athletics/Dream Team Allstars and the respective directors, officers, representatives, members, agents and employees of CheerTime Athletics/Dream Team Allstars, (hereinafter collectively “Releasees”) in the exercise of this authority. I further acknowledge and understand that I will be responsible for any and all medical and related bills that may be incurred on behalf of the Minor for any illness or injury that the Minor may sustain during the CheerTime Athletics/Dream Team Allstars sponsored event (camp, competition, virtual event) and while traveling to and from the site for the CheerTime Athletics/Dream Team Allstars sponsored event (camp, competition, virtual event) whether or not the CheerTime Athletics/Dream Team Allstars event actually occurs.

Appearance Agreement. I understand that CheerTime Athletics/Dream Team Allstars at times produces promotional materials relating to its programs. I understand that as a participant in and/ or spectator of the CheerTime Athletics/Dream Team Allstars sponsored event (camp, competition, virtual event) the Minor may be included in videotapes or photographs taken during the CheerTime Athletics/Dream Team Allstars sponsored event (camp, competition, virtual event). Therefore, without reservation or limitation, I, on my own behalf and on the behalf of the Minor, hereby assign, transfer and grant to CheerTime Athletics/Dream Team Allstars, its successors, assignees, licensees, sponsors, any television networks and all other commercial exhibitors the exclusive right to photograph and/or videotape the Minor and to utilize such videotapes and photographs and Minor’s name, face, likeness, voice and appearance as part of the CheerTime Athletics/Dream Team Allstars sponsored event (camp, competition, virtual event), in advertising and promoting the CheerTime Athletics/Dream Team Allstars sponsored event (camp, competition, virtual event) or in advertising and promoting similar future events, including on CheerTime Athletics/Dream Team Allstars social media sites. I further understand that neither CheerTime Athletics/Dream Team Allstars nor any third party is under any obligation to exercise any of the foregoing rights, licenses and privileges.

I, on my own behalf and on the behalf of the Minor, hereby warrant that I have read this Release and Waiver in its entirety and fully understand its contents. I, on my own behalf and on the behalf of the Minor, am aware that this Release and Waiver releases Releasees from liability and contains an acknowledgment of my voluntary and knowing assumption of the risk of injury or illness. I, on my own behalf and on the behalf of the Minor, further acknowledge that nothing in this Release and Waiver constitutes a guarantee that the CheerTime Athletics/Dream Team Allstars sponsored event (camp, competition, virtual event) will occur. I, on my own behalf and on the behalf of the Minor, have signed this document voluntarily and of my own free will.

Electronic Signature and Acknowledgement

Enter the date and your full name to acknowledge your electronic signature of this document.

Date*

Parent/Guardian Full Name*