DATE: April 6th

TIME: 6:00-8:00pm

LOCATION: OC All Stars - Foothill Ranch

COST: $30(please make checks payable to BECKMAN CHEER)

Participant Name: Grade:

Current School:

Email:

Parent/Guardian Name:

Parent/Guardian Phone #:

Email:

Street Address:

City, State, & Zip Code:

CHEER WORKSHOPGrades: 6th - 11th

I , as a parent or legal guardian of , a minor (hereinafter “Minor”), hereby grant the permission necessary to allow Minor to participate in the Beckman High School Cheerleading workshop. I, in my own behalf and on behalf of Minor, understand by the very nature of the activity, cheerleading, gymnastics and dance carry a risk of physical and permanent injury. No matter how careful the participant and coaches are, how many spotters are used, or what landing surface is used, the risk cannot be eliminated. The risk of injury includes injuries such as muscle pulls, dislocations, broken bones and concussions. The risk also includes catastrophic injuries such as permanent paralysis or even death from landing or falling on the back, neck, or head. I understand these risks and will not hold Beckman High School, Tustin Unified School District or any of its personnel and employees responsible in the case of an accident or injury at any time. I further acknowledge that the School District “TUSD” does not provide liability insurance for this program, nor does the School District provide medical coverage for participants in this activity.

AUTHORIZATION TO TREAT A MINOR

I (We) the undersigned parent(s)/legal guardian of _________________________________________ a minor, do hereby authorize and consent to any x-ray examination, anesthetic, medical or surgical diagnosis rendered under the general or special supervision of any member of the medical staff and emergency room staff licensed under the provisions of the Medicine Practice Act or a Dentist licensed under the provisions of the Dental Practice Act and on the staff of any emergency general hospital holding a current license to operate a hospital from the State of California Department of Public Health. It is understood that this authorization is given in advance of a specific diagnosis, treatment or hospital care being required but is given to provide authority and power to render care which the aforementioned physician in the exercise of his best judgment may deem advisable. It is understood that effort shall be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above treatment will not be withheld if the undersigned cannot be reached.

LIABILITY RELEASE & WAIVER FORM

List any restrictions or special needs we should be aware of:

I, in my own behalf and on behalf of Minor, hereby warrant that I have read this Participant Liability Release and Waiver Form in its entirety and fully understand its contents. I, in my own behalf and on behalf of Minor, am aware that this Participant Liability Release and Waiver Form releases Releasees from liability and contains an acknowledgement of my voluntary and knowing assumption of the risk of injury or illness. I, in my own behalf and on behalf of Minor, further acknowledge that nothing in this Participant Liability Release and Waiver Form constitutes a guarantee that the Event will occur. I, in my own behalf and on behalf of Minor, have signed this document voluntarily and of my own free will.

Signature of Parent or Legal Guardian: Date: Signature of Minor: Date: