UPCOMING EVENTS!
CRYSTAL COAST ALL-STARS
2900-14 Arendell St, Morehead City, NC 28557
252-247-0066
SUMMER CAMP REGISTRATION

Child's Name_______________Age____DOB__________

Parent Name____________________________________
Mailing Address_________________________________
City___________________State/Zip_________________
Home Phone_________________Cell_______________
Email Address__________________________________
Insurance Carrier_____________Policy#______________

What Camp are you registering for?
_______________________ Date___________________


Medical History of Participant
Allergies_____________High Blood Pressure________________
Asthma______________Recurring sore throat/ear infection____
Convulsions__________Medications currently taking__________
Diabetes_____________Pre-existing injury__________________
Migraine Headaches___Medical conditions__________________
Heart trouble_________Abnormal/irregular menstrual cycle____
Mental disorders______Epilepsy/fainting spells______________
Daily Medications and Schedule__________________________

Waiver of Liability
A.  I understand that by taking part in the Crystal Coast all-Stars program there is a
possibility of bodily injury, partial and/or total disability or death to my son/daughter.  I do
hereby grant permission to hospital staff members to administer immediate medical
treatment to my child should he/she be injured.
B.  Crystal Coast All-Stars shall not be liable for injuries that occur to participants in its
program.  All Participants are aware of the potential for injuries to occur during physical
activities conducted through Crystal Coast All-Stars, and each participant voluntarily
assumes this risk of injury.
C.  I also agree not to hold liable Crystal Coast All-Stars, the facilities, and any support
staff for any injury as a result of my sons's/daughter's participation in the above
mentioned program.  This release includes, but is not limited to, any claims of
negligence, dangerous condition, latent defect, premises liability, code violations,
negligent security, failure to warn, vicarious liability, negligent liability, negligent hiring,
negligent supervision, negligent maintenance, or improper/dangerous equipment.
D.  I give Crystal Coast All-Stars the right and permissions to film, photograph or video
tape my son/daughter for use in any form of advertisement for Crystal Coast All-Stars
promotional purposes.  I understand I am assuming all risks inherent in cheerleading,
whether known or unknown, and that by signing this document I am giving up my right
to sue Crystal Coast All-Stars on behalf of my child, whether caused by negligence of
said persons or entities.  
 
Parent's/Guardian's
Signature_________________________Date__________
CHEERSPORT
CHARLOTTE, NC
NOV. 8, 2014

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DEC. 13, 2014

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JAN. 24, 2015

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FEB. 14, 2015

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WILMINGTON, NC
MARCH 14, 2015

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APRIL 18 & 19, 2015