Foxboro Tigers Youth Organization INC. Where Visions And Dreams Come Alive

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Cheerleading Registration Form

Foxboro Tigers Youth Organization Inc.

Cheerleading Participant Registration Form

Participant's Information:

* First AND Last Name:

* Date of Birth:

Address:

City, State, Zip:

Parent/Legal Guardian:

Telephone (H)/(W):

* Emergency Contact Name & Phone Number:

The following information is to ensure that medical personnel have details of any medical concern which may interfere with or alter treatment.

* Allergies or other Medical Information:

Medications and dosage frequencies:

Last Tetanus booster:

I understand and agree to be totally responsible for insurance coverage for my child while he/she is at the FTYO Inc. Programs.

I understand and agree that in case of an accident or illness or injury that I have provided insurance coverage for my child.

Insurance Name:

Name of Policy Holder:

Policy Number:

Family Physician Name and Address:

Family Physician Phone Number:

In case of an emergency, if I, or the family physician, cannot be reached. I hereby authorize my child to be treated by a certified Emergency Personnel. *

Please Check One:

Child (4yrs-12yrs)

Youth (Age: 13yrs-17yrs)

Adult (18 & over)

Please Check One:

Girls/Women

Boys/Men

Program: (Please check)

Cheerleading *

I hereby release and forever discharge and hold harmless FTYO and its successors from any and all liability, claims, and demands of whatever kind or nature which arise or may arise from my child's activities with FTYO. This Release discharges FTYO from any liability or claim against FTYO with respect to any bodily injury, personal injury, illness, death or property damage that may result from participation with FTYO. Permission is granted to FTYO adult volunteers or employees to obtain medical care from any licensed physician, hospital, or medical clinic for any first aid, medical treatment, or dental treatment at such times deemed necessary for physical health purposes. I hereby expressly and specifically assume the risk of injury or harm in the activities and release FTYO from all liability for injury, illness, death, or property damage resulting from the activities. I do hereby grant and convey unto FTYO all right, title and interest in any and all photographic images and video or audio recordings made by FTYO during the Minor’s activities with FTYO, including but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.

* "Signed" Consent of the previous paragraph:

* Date of Consent:

* indicates required fields

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Cheerleading Registration Form