RULES, POLICIES, AND FINANCIAL AGREEMENT

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1 RULES, POLICIES, AND FINANCIAL AGREEMENT I,, Parent/guardian of, have read the Arizona Element Elite registration packet in its entirety. I understand the rules and policies described in the packet, and I agree to abide by these rules and regulations for the entire cheer season. I have also reviewed the rules and regulations with my cheer athlete, and she/he understands them and will abide by them as well. We understand that this packet may need to be modified based on developments throughout the year. These changes will be communicated and are not negotiable as the packet has the potential to evolve and improve. I accept the financial responsibility for the cheer season and understand the all charges that accompany this acceptance. I understand that there are no refunds should we leave or are asked to leave the program. Should I have any issues, whether it is financial, personal, or gym-related, I will contact management immediately in order to avoid any undue stress or tension for my cheer athlete, the gym, or myself. Printed Name SS# Printed Name SS#

2 CHEERLEADER INFORMATION FIRST NAME LAST NAME GENDER BIRTHDATE HOME PHONE HEIGHT SCHOOL GRADE: PRE K 12 AGE AS OF: 8/31/2015 ft. in. F M ADDRESS CITY STATE ZIP Must have both to tryout BIRTH CERTIFICATE YES HEAD SHOT YES CHEERLEADER S CELL CHEERLEADER S MOTHER S PRIMARY PHONE MOTHER S FATHER S PRIMARY PHONE FATHER S Check ALL skills you throw ON THE FLOOR & WITHOUT a spot Standing Standing Series Running None or Back walkover Multiple Back handsprings None or Round off Back handspring Two BHS to Tuck Back handspring Standing Tuck Back handspring Tuck Back Tuck Layout Jumps Tuck Two BHS to Layout Full Standing Full Back handspring Layout Double Full Two BHS to Full Back handspring Full Specialty Skills: Cheer Experience: Stunt Position: WHERE AGE LEVEL NONE FLY BASE BACKSPOT WHERE AGE LEVEL NONE FLY BASE BACKSPOT Check your most advanced stunting skill: Level 1 (No experience or level 1 stunts, preps) Level 2 (Ex. Preps, Extensions, Straight Cradle dismounts and Baskets tosses) Level 3 (Ex. Extended one-legged stunts, Full twisting two-legged dismounts, Single trick basket tosses) Level 4 (Ex. Extended one-legged stunts, Double twisting two-legged dismounts, Kick-full basket tosses, Full-ups) Level 5 (Ex. Double twisting one-legged dismounts, Double twisting basket tosses, Full-ups) Do you have any specific requests? Yes No If yes, please explain: Specific requests for ride sharing/sisters/practice times etc. that are realistic, significant, and valid are accommodated (if possible). To fly, to be on an older team than your normal age group, or to be on a team with higher-level skills than your athlete has, are unlikely to make an impact on rosters.

3 (FOR AZ ELEMENT USE ONLY) CLOTHING T-Shirt: YS YS YM YL AS AS AM AL Shorts: YS YS YM YL AS AS AM AL Sports Bra: YS YS YM YL AS AS AM AL Jacket: YS YS YM YL AS AS AM AL SKILL LEVEL Standing Tumbling Running Tumbling Stunting Base Back Base Flyer Emergency Contact Information: Name: Relation: Cell#: Name: Relation: Cell#: Health Insurance Provider: Policy Number: Group No. Named Insured: Are there any issues regarding restrictions as to pick up or visitation by either parent? YES NO If Yes: AUTHORIZED PICK-UP Should you want to authorize a person other than yourself or your spouse (if applicable) to pick up your cheerleader, we must have this information on file before your child will be released. Authorized Person Name: Drivers License #: State: I understand and accept that I may be placed on a team that is different from teams that I have been placed on in the past. YES NO

4 WAIVER AND MEDICAL RELEASE I,, Parent/Guardian of, am completely aware of the complexity and nature of cheer sport, as well as the dangers and risks associated with participation in this sport, including catastrophic injury, paralysis, disability, and even death. I understand that there are potential risks that I may not be aware of at this time. I have shared this information with my cheer athlete, and she/he has indicated a full understanding of the potential hazards and risks of cheer sport. She/he has voluntarily elected to participate in this sport with the knowledge of the potential dangers and risks. I agree that AZ Element Elite and its employees (including team physicians), successors, agents, and assignees shall not be held liable for any and all risks of property damage, losses, expenses, athlete injury or death that have occurred as a result of my cheer athlete s participation in this sport. I understand that AZ Element Elite has a trained staff and gym physician to conduct first response assessments and treatments at practice and competitions. I am aware that these physicians have urgencies or emergencies in their own private practices, so there is no guarantee that a team physician will be onsite for every practice. However, they will always be accessible and on standby to advise by phone and, if available, to quickly report to the gym to conduct the first-line evaluations. This service is of no additional charge to my athlete, or myself and, is made available to us for convenience and to uphold AZ Element Elite s commitment to safety and wellness. In signing below, I agree that the AZ Element team physicians shall not be held liable for any and all risks of athlete injury/illness, complications of athlete injury/illness, undesirable outcomes related to these conditions, lack of follow up of injury/illness, or any damages, losses, or expenses related to the injury or death that has occurred as a result of my cheer athlete s participation in this sport. This medical service is a courtesy for us parents and our athletes, and in signing below, I acknowledge that this service is intended only for first-aid responses and first-line illness screening and should not be considered a substitute or alternative to proper medical management of any injury or illness. I am aware that it is my responsibility to take my athlete to our family physician for immediate follow up and management of any injury or illness. I am giving permission for AZ Element Elite trained staff and gym physician to render appropriate and necessary treatment for onsite injury or serious illness if I or another parent or guardian cannot be reached. I am also giving permission to the trained staff and gym physician to use their discretion to determine if the injury/illness needs to be escalated to emergency care services. In giving the team physicians and staff directive to take action to best ensure the safety and wellness of my athlete, I am agreeing to assume the financial responsibility for all costs involved with urgent care or emergency care services if higher-level evaluation, treatment, and observation is needed. I will not hold Arizona Element Elite Cheer responsible for any of these costs. My athlete does does not have medical insurance. I have read the entire medical waiver and release, and I acknowledge my understanding and attest that any questions have been answered to my satisfaction.

5 PHOTO AND MEDIA RELEASE I,, Parent/guardian of, authorize Arizona Element Elite Cheer, its successors, and/or assignees unrestricted rights to use my athlete s name, likeness, or appearance on any cheerleading or dance posters, calendars, photographs, flyers, video material, film material, computer software, computer hardware, electronic on-line services or other similar promotional material in any form, content or medium to promote or market Arizona Element Elite Cheer. I hereby release and waive any demand, action, claim, license, royalty, or other form of payment the undersigned, and or his or her agents, representative or assigns, may have based on claims of the undersigned as to the rights of privacy, publicity, notoriety or any other rights arising out of or relating to the use by Arizona Element Elite Cheer photos or media exposure.

6 CREDIT CARD AUTHORIZATION Parent/Guardian: Cheerleader Name: I understand that all tuition payments are due on the 1st of the month. I understand the fee structure as outlined above should a payment be late or returned. Late payments are assessed $15.00, and return payments are assessed $25 or the bank s fee, whichever is greater. I accept the fee schedule for the entire season. I understand that I am responsible for the fees as listed and acknowledge that I am responsible for any changes in banking information should there be a change. I understand and accept that all tuition and fees paid are not refundable. Credit Card: Annual Payment Monthly Payment Visa MasterCard American Express Account Number Exp. Date Code Account Holder Address City State Zip Signature of Cardholder Parent/Guardian Signature:

7 Parent/Guardian: Cheerleader Name: I understand that all tuition payments are due on the 25th of the month to cover the month to follow (July tuition due June 25th). Bank Drafts take up to 7 days to process so the draft will be entered 5 business days prior to the due date to allow time for processing. I understand the fee structure as outlined above should a payment be late or returned. Late payments are assessed $15.00, and return payments are assessed $25 or the bank s fee, whichever is greater. I accept the fee schedule for the entire season. I understand that I am responsible for the fees as outlined and acknowledge that I am responsible for any changes in banking information should there be a change. I understand and accept that all tuition and fees paid are not refundable. Tuition Payment: Annual Payment Monthly Payment Checking Savings BANK DRAFT AUTHORIZATION Bank Name Routing Number (9 Digits) Account Number Name on Account Signature Parent/Guardian Signature:

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