Registration Form

CARLOW UNIVERSITY YOUTH CHEER CLINIC

Sunday, November 12th 1pm-4pm in Kresge Center in the University Commons

Parent and family performance at 4:15pm

Please fill out this form completely and mail it in with your check ormoney order in the amount of $50 no later Monday, November 6thto guarantee a T-shirt.

Please make checks payable to Carlow University Cheer.

Participants will learn: Cheer, Dance, Stunts, and Jumps

  • Sign In and Register on Sunday, November 12th at 12:30pm.
  • Wear t-shirt, shorts, tennis shoes, and long hair in pony tail.
  • Bring water bottle! Snacks will be provided.
  • Game day performance will be on Tuesday, November 14th during halftime at the Men’s Home Basketball Game. Wear Clinic Shirt

PLEASE PRINT ALL INFORMATION:

If you are registering more than one cheerleader, please use separate registration forms.

Student’s Last Name:______First Name:______MI:___

Age:____ Grade:______School:______

Address:______

City:______State:______Zip:______

Home Phone:______Cell Phone:______

Parent/Guardian Name(s):______

Address:______

City:______State:______Zip:______

Email:______

Home Phone:______Cell Phone:______

Other Phone:______

Alternate Contact Information (In case of emergency and parent cannot be reached.)

Alternate Contact Person’s Name______

Phone Number ______

T-Shirt Size(Please circle your child’s size):

Youth Sm (6-8) Y Med (10-12) Y Lg (14-16)

Adult Sm Adult Med Adult Lg

Liability Waiver

I understand that my child, (child’s name ______) will be participating in the Carlow University Youth Cheer Clinic on ______. Since this is a voluntary program, I will not hold the school, staff members, or cheer team members liable for any accidental injury, which may occur. In case of a medical emergency, I do give consent for my child to be treated at the nearest emergency room.

Please list any allergies or health concerns we should be made aware of for your child, and any required special medications or treatments:______

Is there anything else we should know about your child?______

Parent/Guardian Signature______

Date______

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

For Office Use Only:

Payment:‫ Check #______‫ Cash ______

T-shirt:YSYMYLASAMAL

Register Early Space is Limited. All forms and fees are due on Monday, November 6th!

MAIL TO or CARRY TO:

Carlow University Cheerleaders

Attn: Ashley Ganoe, Cheer Coach

3333 Fifth Ave

Antonian Hall

Pittsburgh, PA 15213