Cheerleading Camp Registration Camper InformationCamper* First Last Emergency Contact* First Last Emergency Contact Email* Emergency Contact Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Date of Birth*School attending this fall*Other InformationT Shirt SizeYouth MediumYouth LargeAdult LargeAdult XLAdult XXLDoes the camper have any medical conditions?*YesNoIf so, explain Does the camper have any allergies?*YesNoIf so, explain Disclaimer* I agree to allow 2016 Breaston/Mundy Youth Clinic to use photos, videos and sound recordings my child may appear in. Photos, videos, and sound recordings may be used in media related, promotional and/or sponsorship materials, etc. in the forms of print, video, etc.Waiver of Liability Waiver* I have read and agree to the above release and waiver of liability, assumption of risk and indemnity agreement, fully understand its terms.