ROCKSTAR ATHELTICS ALL-STAR CHEER 2014-2015 REGISTRATION
Please complete the following forms.
Each member must turn in Copy of Photo I.D., Copy of Birth Certificate and Copy of Medical Insurance.
Athlete Name: _________________________ Age as of 8/31/14: ______ Date of Birth: ___/___/______
Address: ___________________________________ City, State, Zip: _____________________________
Parent/Guardian: ______________________________ Cell Phone: ______________________________
Parent/Guardian: ______________________________ Cell Phone: ______________________________
Home Phone: ______________________________ Athlete Cell Phone: ___________________________
Parent Email: __________________________________________________________________________
Athlete Email: _________________________________________________________________________
Who referred you to Rockstar Athletics?: ___________________________________________________
Clothing Sizes
Shirts: YM
Shorts: YM
YL
YL
S
S
M
M
L
L
XL
XL
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)
__LV 5 (Full or Double)
STUNTS (FLYERS)
__LV 1 (Prep w/ straight cradle)
__LV 2 (Single leg stunt 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)
__LV 4 (Kick full)
__LV 5 (Kick double full)
Cheer experience/team?: ________________________________________________________________
Are you interested in more than one team?: _________________________________________________
EMERGENCY PROCEDURES: For minor injuries, Rockstar Athletics policy is to call one of the parents/guardians
listed above, and follow their directions. In the rare case of a more serious injury, Rockstar Athletics policy is to first
call 911, then call one of the parents/guardians listed above. EMERGENCY TREATMENT PRE-AUTHORIZATION: I
authorize Rockstar Athletics and its representatives to consent to medical treatment for my child when I cannot be
reached to so consent. I also give Rockstar Athletics 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 Rockstar Athletics 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: Rockstar Athletics 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: Rockstar Athletics 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 Rockstar Athletics and
its staff and officers harmless for any injury or resulting expenses. I release and discharge all rights and claims
against Rockstar Athletics and its parties.
Please list any physical/psychological limitation, injury, or weakness that may affect athlete:
_____________________________________________________________________________________________
Please list any medications or allergies: _____________________________________________________________
Insurance Carrier: _________________________________ Policy #: _____________________________________
Parent/Guardian Signature: _________________________________ Date: ________________________________