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City & State
Place of employment
Place of employment
Athlete’s Current Grade
Emergency Contact 1
Emergency Contact 2
Medical Conditions / Allergies / Existing Injuries
I, the undersigned parent/legal guardian, do herby grant permission for my child
henceforth the “athlete”, to participate in gymnastics, tumbling, conditioning and cheerleading at Nola All Stars, LLC. In order that my child may receive the necessary medical treatment in the event she/he may sustain injury or illness during participation in this activity, I hereby authorize the cheerleading coach or other supervising adult to obtain medical treatment, at my expense, for my child for such injury or illness during the activity, and I hereby hold Nola All Stars, LLC, it’s representatives and employees harmless of the exercise of authority. I acknowledge that the above participant must have his/her own medical insurance.
I understand that this activity involves risk to the participant. I further acknowledge and understand that due to the nature of this activity, which involves motion, height, inversion or rotation, there is a possibility that my child may sustain physical illness or injury (minimal, serious or catastrophic) in connection with her/his participation. I further understand that my child and I are assuming all risk and cost of such physical illness or injury that may be sustained during participation in this activity. I declare that the athlete has been seen by a physician and is cleared to participate in physical activities such as gymnastics, cheerleading and tumbling.
I further understand that Nola All Stars, LLC has established rules and regulations pertaining to conduct, safety, behavior and activities of all cheerleading and tumbling participants and parents, by which myself and my child must abide while she/he is a member of this cheerleading team/program and that my child and I will be responsible for our failure to abide by those rules and regulations. My child and I have read, understand and agree to all conditions set forth in the medical conditions authorization above and the rules and regulations outlined in the 20-21member packet.
The undersigned does hereby grant Nola All Stars, LLC and its successors the right to use the undersigned’s name, likeness or appearance on any cheerleading, tumbling or similar camp posters, calendars, photographs, evaluation flyers, video material, film material, computer software, computer hardware, electronic on-line services or other similar promotional material in any form, content or medium to promote or market Nola All Stars, LLC. The undersigned does hereby expressly release and waive any demand, action, claim license, royalty or other form of payment the undersigned and his/her agents, representatives or assign, may have based on claims of the undersigned as to rights of private, publicity, notoriety or any other rights arising out of or relating to any use by Nola All Stars, LLC of the athlete and undersign’ s name, likeness or appearance.
Initial next to each of the over-the-counter medications that you approve to be given to your child, if requested:
Parent or Guardian Signature
EMAIL a video showing Jumps, Tumbling and Body Positions (optional) to
Amount to Pay
Amount to Pay
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