JSU Cheerleading Stunt & Tumble Clinic
JSU Cheerleading Stunt & Tumble Clinic Saturday, January 21st, 2017 9:00 a.m. - 12:00 p.m. Old Kitty Stone Gym 115 College Street Jacksonville, AL 36265 High School Seniors and older Cost: $50.00 which includes JSU t-shirt Pre-register online at http://www.jsu.edu/housing/index.html by Monday, January 16th or register and pay at the door Office: 256-782-8386 Email: [email protected] Make Check Payable to JSU and Mail to: Jacksonville State University Athletic Department, Dave Almeida 700 Pelham Road North Jacksonville, AL 36265
APPLICATION AND RELEASE OF LIABILITY J.S.U. OPEN CHEERLEADING CLINIC I apply to attend the Cheerleading Clinic to be held on versity. NAME:
/
/
at Jacksonville State Uni-
Date of Birth:
Gender:
Height:
Weight:
T-Shirt Size:_____________
Address: School: Phone: (
)
In case of emergency, notify: Address: Phone: (
)
Prior Experience: ☐Cheering ☐Gymnastics ☐Dance ☐Sports Do you have any physical or medical problems or prior injuries that would prevent you from safely engaging in or that would limit your ability to engage in physical activities associated with normal cheerleading activities such as jumping, tumbling, or stunting (with a partner)? ☐No ☐Yes: (Give Details of Restrictions / Limits):
GENERAL RELEASE: I, the undersigned, in return for being allowed to participate in the function listed above, which is acknowledged to be good and sufficient consideration, hereby release and forever hold harmless Jacksonville State University, its Trustees, officers, agents, employees and servants, from any and all liability, claim, demand, cost, action or cause of action for injury or damage to person or property of whatever kind or nature which arises, directly or indirectly, or resu lts from my (my child’s) participation in the Cheerleading Clinic to be conducted at Jacksonville State University as referenced above. I acknowledge that Jacksonville State University does not insurer participants against injury or loss of any kind, including medical bills or costs. I fully understand that this is a general release, that I have read and understand the same, that it is intended to and does act as a complete and unconditional release to the fullest extent allowed by law, and that is binding upon me (and my child, if applicable), my (our) heirs, next of kin and / or personal representatives.
Dated:
(x) Student / Participant
Parent / Guardian For Participant Under Age of 19: (x) Print Name:
APPLICATION AND RELEASE OF LIABILITY J.S.U. OPEN CHEERLEADING CLINIC I apply to attend the Cheerleading Clinic to be held on versity. NAME:
/
/
at Jacksonville State Uni-
Date of Birth:
Gender:
Height:
Weight:
T-Shirt Size:_____________
Address: School: Phone: (
)
In case of emergency, notify: Address: Phone: (
)
Prior Experience: ☐Cheering ☐Gymnastics ☐Dance ☐Sports Do you have any physical or medical problems or prior injuries that would prevent you from safely engaging in or that would limit your ability to engage in physical activities associated with normal cheerleading activities such as jumping, tumbling, or stunting (with a partner)? ☐No ☐Yes: (Give Details of Restrictions / Limits):
GENERAL RELEASE: I, the undersigned, in return for being allowed to participate in the function listed above, which is acknowledged to be good and sufficient consideration, hereby release and forever hold harmless Jacksonville State University, its Trustees, officers, agents, employees and servants, from any and all liability, claim, demand, cost, action or cause of action for injury or damage to person or property of whatever kind or nature which arises, directly or indirectly, or resu lts from my (my child’s) participation in the Cheerleading Clinic to be conducted at Jacksonville State University as referenced above. I acknowledge that Jacksonville State University does not insurer participants against injury or loss of any kind, including medical bills or costs. I fully understand that this is a general release, that I have read and understand the same, that it is intended to and does act as a complete and unconditional release to the fullest extent allowed by law, and that is binding upon me (and my child, if applicable), my (our) heirs, next of kin and / or personal representatives.
Dated:
(x) Student / Participant
Parent / Guardian For Participant Under Age of 19: (x) Print Name:
