Stunt Groups and Dance Doubles Application

Please fill out the form below if you wish to be considered for Dance Double or Group Stunt/ Partner Stunt Competition teams.

First Name(required)

Surname(required)

Street Address(required)

TexCity, State and Postcode(required)

Date of Birth(required)

Age as of December 31st 2018(required)

Grade in School(required)

Phone Number(required)

Email Address(required)

Stunt Group or Partner Stunt Applicant(required)

Cheerleading Stunting Skill Level

Basing Skill Level

Backspot Skill Level

Flyer Skill Level

Dance Applicant(required)

Poms

Jazz

Hip Hop

Dance Double, Nominate your partner here

Semi Competitive or Competitive

Would you accept any position on any Signature Cheer &Dance Studio Team?(required)

If no, please specify your requirements such as age group or cheerleading level or dance style.

Please list any medical conditions (required)

Please list 2 emergency contacts to which the participant can be release to in the event that the parents can not be contacted. Please include name, relationship and phone number.(required)

I authorise any licensed physician to render necessary emergency treatment for injury or illness when neither parent can be reached will assume all financial responsability for such treatment, I acknowledge that the above participant must have his or her own ambulance insurance. I understand that cheerleading and or dance has an inherent danger in participation and in spite of all precausions and injury prevention injuries do occur. I further acknowledge that each participant has elected to participate in Signature Cheer & Dance Studio at their own risk and will not hold Signature Cheer & Dance Studio or its Staff, Instructors or Coaches liable for any and all injuries that may occur while participating in any cheer or dance related classes, camps, clinics, workshops, competitions or events. I the parent guardian of the above listed athlete hereby grant Signature Cheer & Dance Studio and its successors, the unrestricted right to use the above listed athletes first name, likeness, or appearance (photo`s and video`s) on any Cheerleading or Dance posters, calendars, tryout flyers, photographs, video`s, social media, website other similar promotional material in any form, content or medium to promote Signature Cheer & Dance Studio.(required)

Parents Name (required)

I agree to the above mentioned conditions.

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