REGISTRATION FORM

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Mail registration form and check made out to:

Cassandra Montgomery P.O. Box 5, Lafayette, CA 94549-0005
confirmation email will be sent with more details!

Camp Dates: Jul 2 & 3 , 2008 & Practices from 3:30-5:30

Jul 4, 2008 - Perform at Orinda Parade

Camp Fee: $80 (includes special cheer shirt, BB Hat, poms & snacks)

Name of student______________________________________________

Address______________________________ Phone_________________

School________________________________ Grade_________________

Friends attending camp_______________________________________

Circle preferred sweatshirt size:YS 6-8 YM 10-12 YL 14-16 AS
Participant already has shirts & poms_______

Parent Name_________________________ Email_______________________

Phone # where parent can be reached during camp__________________

MEDICAL INFO :

Family Doctor _____________________________ Phone___________________

Insurance_________________________________ Policy# __________________

Asthma - yes no Diabetes - yes no Allergies - yes no

Allergic to _________________________________________________________

Medication currently taking____________________________________________

Additional Medical Information may be helpful________________________________________________________________________

_____________________________________________________________________________________________________________

In the event of an emergencyoccuring while my son/daughter is at Cassandra Montgomery's sponsored class or performance , I grant permission to Cassandra Montgomery/All That Ent and their employeesor reps to take whatever action is necessary

parent initial___________________________

In the event that I cannot be reached , I hereby authorize Cassandra Montgomery/ All That Ent. & it's employees or reps to give consent for my son /daughter to receive medical treatment.

parent initial __________________________

Parent/Guardian Permission:

I understand that my child named above will be attending the cheerleading/dance camp on Jul 2, 3, & 4, 2008. I understand that there are risks involved in any dance or cheer activity and I will not hold Miramonte High School, any of Miramonte personnel, All That Entertainment or Cassandra Montgomery, responsible in case of accident or injury at any time during the camp or game activity.

____________________________ ___________________________________

Parent / Guardian Signature Date

REGISTRATION FORM

Cassandra Montgomery P.O. Box 5, Lafayette, CA 94549-0005 confirmation email will be sent with more details!

Cassandra Montgomery P.O. Box 5, Lafayette, CA 94549-0005
confirmation email will be sent with more details!