NORTH ALLEGHENY SPORTS NETWORK Athletic Director

2007 CHEERLEADING MINI CAMP APPLICATION

North Allegheny Cheerleaders Mini Camp Application

I attend _______________ School     E-Mail Address: __________________

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Cheerleaders Last Name               First Name                    Nickname

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Address                                           City             Zip Code             Phone

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Date of Birth (Month/Day/Yr)           Age            Grade Entering Fall 2007

Place me with one friend:_________________________________________

Please Circle T-Shirt Size: Child S(6-8)   M(8-12)   L(12-16)  or  Adult  S  M  L   XL

Shirts will be available for sizing at Registration and Shorts will be available for purchase).

HOAGIE SALE (Wednesday 6/13 Delivery) - $4.00/Hoagie:  ______ X 4.00 = ______ Total Due

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  Fathers Name                                                   Mothers Name

By my signature(s),  I (we) give approval for the above child to participate in any and all activities of the Cheerleading Mini Camp. I (we) assume all risks and hazards incidental to the conduct of the activities and transportation to and from all activities and practice. I (we) agree to release, absolve, indemnify, and hold harmless the North Allegheny Cheerleaders, its officers, directors, coaches, and supervisors in the case of injury to our child during these activities and when being transported to or from these activities.

Medical Authorization

Allergies or Medical History we should be aware of (include Medications)

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To whom it may concern: If neither parent can be contacted in the case of injury or illness, I hereby authorize representatives of the NA Cheerleaders Camp to act as my agent to secure emergency medical treatment

For_________________________________________________, a minor child for whom I am responsible, at the nearest hospital, when in the opinion of the representatives, such emergency medical treatment is deemed appropriate during the time when my child is engaged in the camp activity. I hereby agree to hold the NA Cheerleading Camp and it’s representatives harmless for exercising it’s judgment in authorizing such emergency treatment and said representatives are specifically authorized to sign any required medical emergency hospital treatment form on my behalf.

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Parent Guardian Signatures                                                                               Date

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Family Physician                                                                                        Phone Number

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Nearest Relative/Neighbor                                                                      Phone Number

                                    Refunds may be given on an individual basis minus cost incurred.

CAMP USE: REGISTRATION FEE CHECK #____________________    CASH____________________

QUESTIONS SHOULD BE ADDRESSED TO ATHLETIC DIRECTOR BOB BOZZUTO AT 724-934-7238