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
City
State / Province
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
*
Cheerleading
Pom Dance
Tumble Classes (Join our waitlist!)
3 - 6yrs Cheer Class
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
City
State / Province
Postal / Zip Code
Athlete (if over 18)/Parent/Guardian Signature
*
Clear
Submit
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