Mehlville
Camp *Must pre-register by February 21, 2014 in order to be guaranteed a T-Shirt*
March 1st, 2014 9:00a.m.-12:00p.m. 2 Years old- Pre-K (must have parent with them at all times) th Kindergarten-7 grade (have parents come in and check you in)
Mehlville High School 3200 Lemay Ferry Road St. Louis, Mo 63129
Spend a day with the Mehlville Cheerleaders and learn cheers, jumps, dances, games and stunts! Prices include a T-Shirt, craft, and a snack. Raffle baskets will be available ($1.00 per ticket) A country theme will take place (feel free to dress the part). $30.00 per participant Same family, 2nd child…only $20.00 Walk-ins welcome! Didn’t pre-register? No biggie, see you there! We will have extra forms for you to fill out. Check out www.mehlvillecheerleading.weebly.com for camp information and inclement weather updates/cancellations. All students must have a camp release prior to participation.
MHS Kids Camp Release Form Return to MHS Athletic Office by February 21, 2014 Attn: Allison Scott 3200 Lemay Ferry Road St. Louis, Mo 63125 Payment Method: _____ Cash_____ Check Amount: ________________ T Shirt Size: _____ Youth XS _____ Youth Medium _____Adult Small _____Adult Large
_____Youth Small _____Youth Large _____ Adult Medium _____ Adult XL
*Must pre-register by February 21, 2014 in order to be guaranteed a T-Shirt* Participant’s Name _________________________________
Age ___________
Address ____________________________________________________________ City _______________________________ State ___________ Zip ___________________ Participants Date of birth _____/_____/_____ Parent/Legal Guardian’s Name ___________________________________________ Home Phone __________________ Cell Phone ______________ Work Phone _____________ E-mail Address _________________________________________________________________ IN CASE OF EMERGENCY Contact Name _____________________________________________________ Address __________________________________________________ Home # ___________________________________________________ Cell # ______________________ Work# ________________________ Participant’s Allergies: ___________________________________________________________ Participant’s Medical Conditions: _________________________________________________
MEDICATIONS CANNOT BE GIVEN TO ANY CHILD OR ANYONE EMPLOYED BY MHS STAFF
WAIVER OF LIABILITY AND CONSENT FOR MEDICAL TREATMENT I voluntarily agree to participate, or for my children to participate, in Mehlville High School Kids Cheer Camp on March 1, 2014. I hereby waive, release, and hold harmless from any liability for damages or claims for damages for personal injury, injury, including accidental death, as well as from claims for property damage which may arise in connection with the above named activity, against the Mehlville High School/Mehlville School District and its elected and appointed officials, agents, and employees. As parent/guardian, I hereby consent to treatment of my minor child for any and all medical procedures deemed necessary as a result of accident or injury. I further agree to pay any and all cost incurred as a result of said treatment. I hereby give permission to the Mehlville High School Staff to use my or my children’s photographs as they see fit in their promotional events and webpages. I understand the photograph belongs to the Mehlville High School Cheerleading Program and I will not receive payment of any kind. I hereby certify that, as the parent/guardian for my child, I have legal responsibility for and authority to sign this RELEASE AND WAIVER on behalf of my child. I further certify that I have read this RELEASE AND WAIVER in full, understand the same and have signed it voluntarily and without any duress or coercion. Parent/Legal Guardian Signature ________________________ Date ___________________ Parent/Legal Guardian Printed Name: _____________________________________________ Participant’s Printed Names: _______________________________ _______________________________ _______________________________ _______________________________ _______________________________