New Athlete Registration

Ultimate Cheer

Athlete Registration Form
Athlete First Name *
Athlete Last Name *
Athlete date of Birth *

Day Month Year
Date
Address *

Street Address

Street Address Line 2

Postal / Zip Code
Contact Email *
example@example.com
Contact Phone Number *

Area Code Phone Number
What class would you like to join? *

Kids, Mondays 6-7.30pm Adult, Mondays 7.50-9.20pm
Select reason for registering *

I would like to join a non-competitive team (can join at any point in season) Tryouts (5 -17 yrs) Tryouts (18+ yrs Cheer) Tryouts (18+ yrs Pom dance) 3 - 4yrs Class (Heartbreakers) Waitlist Open Gym (18+yrs) Holiday Camp School Club Attending Birthday Party
Please list any Cheer/Gymnastics/Dance experience (don't worry if you are brand new to Cheerleading):
School Name:
Birthday child's name:
Do you have a promo code? Please enter it below:
Emergency Contact Information
Emergency Contact First Name *
Emergency Contact Last Name *
Relation to Athlete *
Emergency Contact Phone Number *

Area Code Phone Number
Health History
Have you had any previous injuries/operations? *

Yes No
Please specify
Do you have any ongoing medical conditions? (E.g. Asthma, shoulder problems) *

Yes No
Please specify
Do you have any known allergies? Including any allergies to medication? *

Yes No
Please specify
Are you currently taking any medication? *

Yes No
Please specify
GP Name
GP Phone Number

Area Code Phone Number
GP Address

Street Address

Street Address Line 2

Postal / Zip Code
Athlete (if over 18)/Parent/Guardian Signature *

Clear
Should be Empty:

Ultimate Cheer

Emergency Contact Information

Health History