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2015-­‐2016 Louisiana Elite Allstars Registration Pre-­‐Registration Fee (before May 22): $20.00 Walk-­‐up Registration (May 22): $25.00 **Fees are non-­‐refundable** Schedule For Team Placements Ages 4 – 9 from 4:00–6:00pm Ages 10 – 18 from 6:00-­‐8:00pm **Age as of August 31, 2015. New members must bring a copy of their birth certificate** LA Elite holds the right to place athletes at its discretion. Athletes will be placed on a team based on his/her age AND skill ability Cheerleaders Name: _______________________________________ Gender: __________________________ Parent/Guardian: ____________________________________________________________________________ Address: ____________________________________________________________________________________ Cell Phone: (______)________________________ Child’s Cell: (______)________________________ Contact Email: ______________________________________________________________________________ School: _____________________________________ Grade (’15-­‐ ‘16): ________ Age *as of August 31, 2015*: ________ Date of Birth: ________________________ BACKGROUND EXPERIENCE (for new members only) Cheerleading Experience (School and/or all-­‐star): ____________________________________________________________________ Tumbling Experience: ___________________________________________________________________________________________________ Stunting Experience: Check all that apply ______Top (flyer) ______ Main Base ______Secondary Base ______ Back Spot Most Advanced Stunt: ___________________________________________________________________________________________________ Team Placement Release/Waiver Louisiana Elite Allstars, LLC, Kelsey Collins, Members, Employees, and Volunteers are not responsible for loss or injuries. A completed parental release form must be signed and turned in for each participant. Participants will not be allowed to participate without a properly completed and signed form. Athlete Name: ____________________________________ Date Of Birth: __________________________ Parent/Guardian: ____________________________________ Phone # __________________________ Please list any information about your child that we should know about including any diagnosed medical conditions or other distinctive factors. (Asthma, ADD, ADHD, Allergies, Focus Difficulties, Etc.) __________________________________________________________________________________________________ I, _________________________, hereby certify that the above named child, __________________________ has permission to participate in cheerleading, tumbling, and trampoline. I agree to hold harmless and to indemnify Louisiana Elite Allstars, LLC, Kelsey Collins, all respective officers, members, employees, and volunteers from any liability, claims of disability, suits, actions, judgments, damages, cost and expenses or arising from or as result of any injury sustained by the participant in any activities at Louisiana Elite Allstars, LLC, even if such injury is caused in whole or part by negligence by any party or indemnified hereunder. I agree that this release, waiver and indemnification agreement will be enforceable against me, my heirs, personal representatives and assigns, to the fullest extent of the law. Louisiana Elite Allstars, LLC reserves the right to refuse service and terminate contract at any time or for any reason decided by Kelsey Collins. I agree to abide by the decisions of the owners and staff at Louisiana Elite Allstars, LLC. Parent/Guardian: ____________________________________ Date: _____________________________ Print Name: ____________________________________ Emergency Contact: ____________________________________ Phone # _________________________ Relationship To Athlete: ____________________________________ Louisiana Elite Allstars 709 S. Lewis St. New Iberia, LA 337.781.3602 www.elitecheerleadingacademy.com