PLEASE PRINT
Cheerleader’s Name _______________________________________________________

Address _____________________________ City ________________ Zip ___________

E-mail address _________________________ Home Phone _______________________

School Name ____________________________Grade ___ Sports Cheered for ________

Coaches Name ____________________________ Home Phone ____________________

Varsity Sport(s) for which he/she cheers  ________________________________________

T-shirt size __________  Shorts size __________

Parental Consent Form 

I (We) the undersigned parent(s)/guardian(s), do hereby grant permission for my above named son/daughter, to participate in the Iowa All-Star Cheerleading Program.

I (We) acknowledge and understand the following: 

1. That while participating in this event there is a possibility of illness or injury to my son/daughter.  I (We) further acknowledge that my son/daughter is assuming the risk of such physical illness and/or injury by his/her participation.  I (We) further release ICCA/IHSAA, as well as its representatives, from any claims for personal illness and/or injury that my son/daughter may sustain as a result of his/her participation.

2. In order that my son/daughter may receive emergency medical treatment in the event of illness or injury during this event, I (We) hereby authorize the ICCA representatives to obtain medical treatment for my son/daughter for such illness or injury.  I (We) hereby hold the ICCA/IHSAA and its representatives harmless in the exercise of this authority.  I (We) agree to be responsible for any and all medical bills that may be incurred on behalf of my son/daughter as a result of his/her participation in this event.

3. The ICCA and the IHSAA have established rules and regulations regarding conduct, safety, and sportsmanship by which my son/daughter must abide, and that my son/daughter and I (We) will be responsible for his/her failure to abide by those rules and regulations.

   I (We) have read and understand A, B, and C above and give my child permission to participate.

 

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      Parent/Guardian Signature                                                 Date

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Parent/Guardian Signature                                                  Date