All That Entertainment

ÒKids CampÓ the cheer experience

REGISTRATION FORM

   Warriors Prime Time Performance

K-8th Grade

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Mail registration form and check payable to:

Cassandra Montgomery P.O. Box 5, Lafayette, CA 94549-0005

CONFIRMATION EMAIL WILL BE SENT WITH MORE DETAILS! 

Camp Dates

WARRIORS GAME:

February 17th, 19th 2009 Practices from 4:00 - 6:00 pm

            Lafayette Veterans Memorial Center 

February 21st, 2009 Perform at Oracle Arena ÒWarriors GameÓ

Cassandra Montgomery is supporting performing arts programs at the Lamorinda schools. 
For each game ticket purchased $5 will be donated back to EFO and LASF. 
Katie Behnke from Miramonte High School will sing the National Anthem at the game. 

Camp Fee:    $150 (includes ticket to the game with dinner voucher,  

Special uniform cheer shirt, pom pons, bows and snacks)

 

Name of student____________________

Address__________________________

Phone_________

School____________

Grade_____

Friends attending camp_____

Circle preferred shirt size:YS 6-8    YM 10-12    YL 14-16    AS

Parents Names_______________

Email______________

Phone # where parents can be reached during camp:_____________

Mother_____________

Father____________

Medical information:

Family Doctor____________

Phone____________

Insurance____________

Policy #____________

Asthma  yes  no        Diabetes  yes  no                Allergies  yes  no

Allergic to____________

Medication currently taking____________

Additional Medical Information that may be helpful______________________________

In the event of an emergency occurring while my son/daughter is at Cassandra MontgomeryÕs sponsored class or performance, I grant permission to Cassandra Montgomery/ Golden State Warriors and their employees or representatives to take whatever action is necessary. ___________________

Parent initial.__________

In the event that I cannot be reached, I hereby authorize Cassandra Montgomery/ Golden State Warriors and itÕs employees 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 at Lafayette Veterans Hall on February

 17Ð 19, 2009.   I understand that there are risks involved in any dance or cheer activity and I will not hold Lafayette Veterans Hall, Contra Costa County, any of Lafayette Veterans Hall personnel, All That Entertainment or Cassandra Montgomery, responsible in case of accident or injury at any time during the camp or game activity.  All participants must sign a separate medical liability and media release before joining in activities.

Parent / Guardian Signature ____________

Date____________