AACD Season 3 Application

Athlete's Name (Please be sure spelling is correct.)*

First NameMiddle NameLast Name

Athlete's Birthday

Date

What Grade is your child in?

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Email:*

example@example.com

Parent/Guardian Phone Number*

Area CodePhone Number

Emergency Contact Name*

First NameLast Name

Emergency Contact Number*

Area CodePhone Number

Child's Insurance Provider*

(United Health Care, BCBS, Medicaid, etc. )

Child's Insurance Provider ID*

(Please enter the Insurance Member ID)

How did you hear about us?*

COVID-19 INFORMATION
Ensuring the health and safety of our students and staff is a top priority. All athletes are expected to behave in a manner that supports social distancing and general safety.

KEEPING AACD SAFE

I agree and understand that in order to comply with the state and local agencies my child(ren) will not be in attendance of class if showing any signs or symptoms of COVID-19 or been exposed to someone with COVID-19 (below) will be asked to withdraw from AACD's practice. A doctor’s release and 14-day self-quarantine are required upon re-entry to our classes.

Cough
Shortness of breath or difficulty breathing
Fever
Chills
Muscle Pain
Sore Throat
New loss of taste or smell

This is a list of possible symptoms. Other less common symptoms have been reported, including gastrointestinal symptoms like nausea, vomiting, or diarrhea.

Finally, this agreement indicates that I release, hold harmless, and exonerate All About Cheer and Dance, LLC from any liability that may occur during the use of any All About Cheer and Dance, LLC activity.

Have you read the Covid-19 Waiver above and agree with all its terms and conditions?*

I agree

Health History*

	No	Yes	Please Explain.
Does your child have any restrictions on activity?
Will your child need any special assistance while at any practice/event/performance?
Is there anything else you feel we should know health wise about your child? Please list any other medical information the coaches should have about your child.

Medical Questions *

	No	Yes	If yes, please explain.
Does your athlete have any allergies?
Does your athlete require an EpiPen or Inhaler? IF YOUR CHILD REQUIRES AN INHALER, SHE MUST BRING TO EVERY PRACTICE OR PROVIDE ONE TO THE COACHES AT THE STAR;T OF THE SEASON! NO EXCEPTIONS.
Does your athlete have any dietary restrictions?

May over-the-counter medications be given to your child while at any practice/performance/event? *

	No	Yes
Acetaminophen (Tylenol)
Ibuprofen (Advil)
Antihistamines (Benadryl, Diphenhydramine)
Sunscreen
Bug Repellant (Off Spray)

Medical Waiver

PERMISSION FOR EMERGENCY MEDICAL TREATMENT/MEDICAL INSURANCE: I confirm that my child is in good health and that I have medical insurance on my child and will provide coverage while he/she is enrolled. I hereby authorize simple first aid and consent to any x-ray, exam, and medical or surgical diagnosis that is deemed necessary in case of emergency and RELEASE, DISCHARGE AND COVENANT NOT TO SUE for any negligent medical efforts expended on my behalf or on behalf of the minor. Additionally, I hereby agree to individually provide for all possible future medical expenses which may be incurred by my child as a result of any injury sustained while participating at or for All About Cheer and Dance Company LLC.

Clicking the box below confirms that you have read the Medical Waiver, that you understand it, and that you agree to be bound by it.*

I agree

Liability Waiver and Media Release

ASSUMPTION OF RISK, WAIVER OF LIABILITY: As legal guardian of the above named persons, I RECOGNIZE AND FULLY UNDERSTAND THAT POTENTIALLY SEVERE INJURIES, INCLUDING PERMANENT PARALYSIS OR DEATH can occur in sports or activities involving height or motion, including but not limited to gymnastics, tumbling, cheerleading, etc. These Risks and dangers may be caused by my own or my child’s actions, or inactions, the actions or inactions of others participating in the activity, or the negligence of All About Cheer and Dance Company officers, directors, employees or other representatives, whether paid or volunteer. BEING FULLY AWARE OF THESE DANGERS AND IN CONSIDERATION of the minor being permitted to participate in activities at this facility, I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I, or my child, incur as a result of my child’s participation in the activities at this facility. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS All About Cheer and Dance Company, LLC, on my own behalf and the behalf of my child and our respective heirs, administrators, executors, and successors, its officers, directors, employees or other representatives, whether paid or volunteer, FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES, WITHOUT LIMITATIONS, ON THE MINOR’S ACCOUNT OR MINE caused or alleged to be caused in whole or in part by the negligence of All About Cheer and Dance Company, LLC, its officers, directors, employees or agents. Once fees of any kind are paid to AACD, fees are NON-refundable.

Media Release

Photographs and Videos: I give permission for photographs and videos of my child to be used in print or broadcast media or posted on the internet as deemed appropriate for the promotion of any All About Cheer and Dance Company, LLC activities.

Clicking the box below confirms that you have read the Waiver of Liability and Media release, you understand it, and will at all times abide by (and have my child abide by) all rules and regulations set forth by All About Cheer and Dance Company, LLC*

I agree

Monthly Tuition Notice

I agree and understand that the $60 Monthly Fee/Athlete is due to All About Cheer and Dance Company LLC on the FIRST of each month.

After the 5th of each month, fees are considered LATE and a $30 late fee will be automatically added to your child's account balance for the month.

If fees are not paid in full by the first of the following month, your child will be unable to attend any practice/event/performance of that month and possibly beyond.

Clicking the box below confirms that you have read the Monthly Tuition Notice, that you understand it, and that you agree to be bound by it.*

I agree

Name of Parent/Guardian that agrees and adheres to the above Medical Waiver, Liability Waiver, Media Release, and Monthly Tuition Notice.*

First NameLast Name

Please Upload a SCANNED and LEGIBLE copy of Athlete's Birth Certificate. (Birth Certificates will NOT be shared outside of AACD, LLC besides the use of registering for city/county sports if required! )*

Please Upload a Photo of your Athlete. (a headshot taken within the LAST MONTH please!)*

Required Fees*

Registration Fee$55.00

A fee of $55.00 is required to register with AACD. Application will not be considered and Registration is incomplete without this payment. Payments submitted are non-refundable. Thank You!

Late Registration $400.00

Any athletes registered after July 27th , a $400 Late Registration Applies. Payments submitted are non-refundable. Thank You!

First Months Tuition $60.00

AACD’s monthly tuition is $60.00. This covers the first months tuition ONLY Payments submitted are non-refundable. Future monthly payments are paid via invoices sent by text or email every 1st of the month.

Enter coupon

Total $0.00

Payment Methods

Credit Card

Apple Pay

ACH Bank Transfer

Afterpay