File - Fleming Island High School

Fleming Island High School
Cheerleaders Present:
Eaglet Chee r Camp
 Saturday, August 1st, from 9am-2pm
 Ages 4-12
 Fleming Island Gymnasium
 Cost: $50 (make checks payable to “FIHS”)
 Please bring a sack lunch and plenty of water
The cheerleaders will be learning chants, jumps, and a dance with the Fleming Island
Cheerleaders! Each participant will receive a T-shirt and will perform with the Varsity
Cheerleaders at the pre-season football game on August 20th Vs. Westside HS.
Name: _________________________________________________________ Age: ___________
Parent’s Name: _________________________________________________________________
Phone Number: ________________________________________ Shirt Size: _______________
Address:
_________________________________________________________________________________________
_________________________________________________________________________________________
Mail this form, payment, and medical waiver by July 15th to:
Fleming Island High School
Attn: Cheerleading
2233 Village Square Pkwy
Fleming Island FL 32003
Email Questions to:
Janae O’Dell- [email protected]
Amy Mercer- [email protected]
Drop-off this form, payment, and medical waiver by July 15th to:
FIHS Front Office
Monday-Thursday: 7am-12pm and 2pm-5pm
Fleming Island High School Cheerleading
Camp/Clinic Release Form
NAME:
AGE:
____
EVENT:_______________________________________________
PARENT:
______
PHONE:
______________________________
EMERGENCY CONTACT :
______
EMERGENCY PHONE NUMBER(S):
____________
MEDICAL CARE RELEASE AND INSTRUCTIONS
In case of accident or serious illness and I am not reachable by phone, I hereby authorize FIHS Cheer
coaches, FIHS Staff or assistants to contact, at my expense, the appropriate emergency medical personnel and to
follow their instructions. I understand that if emergency care is needed, the parent(s)’ health care insurance will
be primary insurance and there is no secondary insurance available for any intent or purpose available to me.
WAIVER OF RISK/LIABILITY
I hereby give my permission for my child to participate in the cheerleading camps, practices, and/or
tumbling scheduled by Fleming Island Cheerleading Program, and state that my child is physically fit and
capable of participating. I understand that participation is voluntary and agree to hold harmless Fleming Island
High School, coaches, assistants, volunteers, fellow team members and any authorized agents or associates
(“the team members”) for any and all injury or claim of injury caused by or incurred while in the course and
scope of this activity. I agree to hold harmless the “team members” against any and all claims arising out of any
accident or mishap that may result from my child’s participation in the above referenced activities. I understand
that injuries can be severe in nature- including but not limited to broken bones, torn ligaments, paralysis and
even death. I hereby release Fleming Island High School, FIHS Cheer Coaches and the “Team Members” in
this matter and release them of any responsibility in the event of injury, physical problem or health condition
my child might receive as a participant in this event and/or associated practices to prepare for any related event.
I UNDERSTAND THAT MY CHILD’S PARTICIPATION IN ANY ASSOCIATED EVENTS ARE AT OUR
OWN RISK AND WE ASSUME SAID RESPONSIBILITY FOR ANY AND ALL INJURY OR DAMAGES
RESULTING FROM SAID PARTICIPATION INCLUDING BUT NOT LIMITED TO ANY AND ALL
MEDICAL EXPENSES AND/OR PERMANENT INJURIES. PARTICIPATION AND ACCEPTANCE OF
RISK AND RESPONSIBILITY IS 100% VOLUNTARY AND ACCEPTED.
DATE
PARENT/GUARDIAN