Parental Consent Form In order to enable health facilities to provide prompt care of your child, we urge you to read and complete this consent form. This will enable us to help your child without delay.
Name of Camper __________________________________
Age ___________ Grade next Fall __________________
City, State, Zip____________________________________
Contact Phone ____________________________________
Allergic Reactions (Drugs, Asthma, Bee Stings, etc.) No_____
Yes (Please Describe)_______________
Taking Medications No_______ Yes_________
Emergency Contact _______________________________
T-shirt size Adult XL L M S Youth L M S
WE THE UNDERSIGNED HEREBY CERTIFY THAT I AM THE PARENT/ LEGAL GUARDIAN OF THE CAMPER. I HEREBY GIVE PERMISSION FOR THE STAFF OF THE CAMP TO SEEK APPROPRIATE MEDICAL ATTENTION FOR THE CAMPER, AND FOR MEDICAL ATTENTION TO BE GIVEN, AND FOR THE CAMPER TO RECEIVE MEDICAL ATTENTION IN THE EVENT OF AN ACCIDENT, INJURY OR ILLNESS. I WILL BE RESPONSIBLE FOR ANY AND ALL COST OF MEDICAL ATTENTION, AND TREATMENT, AND HAVE MEDICAL INSURANCE TO COVER THESE COSTS. I UNDERSTAND THAT CHEERLEADING IS A PHYSICAL SPORT AND INJURIES CAN OCCUR. I ALSO UNDERSTAND THAT THERE ARE LIMITED NUMBER OF COACHES AND THAT OUR CHILD CANNOT RECEIVE INDIVIDUALIZED ATTENTION ALL THE TIME. WE WAIVE, RELEASE AND FOREVER DISCHARGE THE MEADE COUNTY CHEERLEADERS CAMP AND ITS STAFF FROM ALL RIGHTS AND CLAIMS FOR DAMAGE OR INJURY TO PERSON WHICH MAY BE SUSTAINED DURING PARTICIPATION IN CAMP ACTIVITIES OR WHILE AT CAMP, WHETHER OR NOT DAMAGES, INJURY, OR LOSS IS DUE TO NEGLIGENCE.
Guardian Signature_____________________________ Date____________________
FOR MORE INFORMATION:
Rachel McNulty firstname.lastname@example.org
Meade County High School Cheer Coaches: Rachel McNulty Jenna Gerkins Ashley Reeder
Campers will receive instruction on:
Cheers & sidelines
And much more!
All campers will receive lunch daily and a
All campers must be school-age and attend Meade County Schools. Students entering grades K-8 for the 2018-2019 school year are eligible to participate at camp. Campers should wear shorts, T-shirts, tennis shoes, and socks. An awards ceremony and team performances will be held on Friday, July 20st at 11am in the Main High School Gym.
Pre-register by mail before July 1st: - $50/camper - $40/camper (more than one camper per family)
Register at the door on July 16th: - $60/camper - $50/camper (more than one camper per family)
To Register for Camp:
Complete the Parent Consent Form on the back of this page.
Mail it by July 1st along with your payment to:
Rachel McNulty 1085 Old Ekron Road Brandenburg, KY 40108
Please make checks or money orders payable to: MCHS Cheer Boosters
Payments must be received by July 1st for pre-registration.