United Elite Allstars
2014-2015 Registration
Age on August 31, 2014:____________
Athlete Name:______________________________________________________ Date of Birth:________________________
Address:___________________________________________________City/Zip:_______________________________________
Parent/Guardian:_________________________________________________Cell phone:____________________________
Parent/Guardian:_________________________________________________Cell phone:____________________________
Home phone:_______________________________________________________________________________________________
Parent email:_______________________________________________________________________________________________
Athlete email:______________________________________________________________________________________________
Who referred you to United Elite? :______________________________________________________________________________________
Clothing Sizes-
Shirts YXS YS YM YL YXL AXS AS AM AL AXL AXXL
Shorts YXS YS YM YL YXL AXS AS AM AL AXL AXXL
Place an “x” next to the skills you currently have (this will not determine your team placement)
TUMBLING
__LV 1 (No back handspring)
__LV 2 (back handspring)
__LV 3 (back tuck)
__LV 4 (layout or standing tuck)
__LV 5 (full or double)
STUNTS (flyers)
__LV 1 (prep w/straight cradle)
__LV 2 (liberty at prep level)
__LV 3 (full twisting cradle)
__LV 4 (single down from single leg)
__LV 5 (double down from single leg)
TOSSES (flyers)
__LV 2 (straight up extension)__LV 3 (full twisting straight ride)
__LV 4 (kick full)
__LV 5 (kick double full)
Cheer experience/team?:________________________________________________________________________________________________________________
Are you interested in being on more than one team?_________________________________________________________________________________
Medical Authorization and Liability Release
EMERGENCY PROCEDURES: For minor injuries, United Elite policy is to call one of the parents/guardians listed above, and follow their
directions. In the rare case of a more serious injury, United Elite policy is to first call 911, then call one of the parents/guardians listed
above.
EMERGENCY TREATMENT PRE_AUTHORIZATION: I authorize United Elite and its representatives to consent to medical treatment for
my child when I cannot be reached to so consent. I also give United Elite permission to administer the necessary emergency care to my
child to stabilize and/or improve the current injury or condition that my child may have sustained during activities related to United
Elite instruction, practices, or performances. No prior determination to life threatening emergency or danger of serious or permanent
injury resulting from treatment need be made under this authorization.
MINOR INJURIES/OTC MEDICATION: United Elite will provide bandages for minor cuts and scrapes. We will provide the recommended
dosage of Acetaminophen/Ibuprofen for your child UNLESS initialed here:___________
We will NOT provide any other medications.
SAFETY PROCEDURES/LIABILITY RELEASE: United Elite strives to provide the maximum in safety procedures, guidelines, and
enforcement, and therefore assumes no responsibility for any accidents or injuries that may occur. I am fully aware that any activity
involving motion, height, athletic activity, and/or gymnastic equipment (ie Tumbl-trak, trampoline, etc) creates the possibility of
serious injury, and I further agree to hold United Elite and its staff and officers harmless for any injury or resulting expenses. I release
and discharge all rights and claims against United Elite and its parties .
Please list any physical/psychological limitation, injury, or weakness that may affect athlete:
.____________________________________________________________________________________________________________________________________________
Any medicines allergic to:__________________________________________________________________________________________________________________________
Insurance Carrieer:_____________________________________________________________________Policy number:______________________________________________
Parent/Guardian signature:_________________________________________________________________Date:_____________________________________
1312 W 9th St. Suite L, Upland CA 91786 (909)946-9313
www.ueacheer.com