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Online Registration Form

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2015 Fall/Winter Cheer Competition and Dance Expo Registration

* Indicates required field

Student Name *

First

Last

Student Age *

Level *

Gender *

Male Female

Instructor *

Class Location *

Parent Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

I, the undersigned, as parents/legal guardian of the child registered on this form do hereby voluntarily submit their application for attendance and participation in the Athletes in Motion, LLC / AIM USA, INC. competition / expo and hereby assume full responsibility for any and all damages, injuries, or losses that they may sustain or incur, if any, while attending or participating, and I waive all claims against the promoters, or operators, or sponsors of Athletes in Motion, LLC / AIM USA, INC. individually or otherwise for any claim or injuries that they may sustain. I fully understand that any medical treatment given to my child will be of a first aid treatment type only. I consent that any pictures furnished by me or my child or any pictures taken of me or my child in connection with the competition / expo can be used for publicity, promotion, videos or television show, and I waive compensation in regards thereto.

Parent Electronic Signature *

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