Participants Name *

First Name

Last Name

Parent / Guardian Name *

First Name

Last Name

Phone *

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Medical Liability *

By clicking this, I verify I have the required insurance for the participant. Insurance coverage for injury is required by all participants. I hereby authorize any medical treatment which may be advised or recommended. 

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

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Photo Liability *

By clicking this, I understand that participation in this event is by my own volition, and I and all parties on my behalf, agree to absolve and hold harmless Shamea Shares Inc., the Sponsors, the Promoters, the Suppliers, the Vendors, the Operators, the Volunteers, and the Special Guests of this program and all others involved with the Shamea Shares Cheer & Dance Clinic. I assume fullresponsibility for any risk occurring from my child’s participation. I release the administration and the employees of this organization from responsibility in case of illness or injury of my child, whileparticipating, performing, including traveling. I give permission to use my child’s name and likeness for any promotional use.