MEDICAL AUTHORIZATION
I/We the parent(s) of the named applicant hereby certify that my child has been EXAMINED by a physician and in doing
so the physician DID NOT find any reason to disqualify his/her from participation in the Houston Cheer & Dance Palace Cheerleading Activities. 
 

PARENTS AUTHORIZATION TO PARTICIPATE
I/We the parents of the above named applicant to the Houston Cheer & Dance Palace hereby give my/our approval to said applicant’s participation in any and all activities during the current season. The parents acknowledges, appreciates, and agrees that: The risk of injury to my child from the activities involved inthis program is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and for myself, spouse, and child, I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsibility for my child’s participation; and I myself, my spouse, my child, and on behalf on my/our heirs, assigns, personal representatives and next of kin, hereby release the other participants, sponsoring agencies, sponsors, advisors, and if applicable, owners and lessors of premises used to conduct the event (releases), with respect to any and all injury, disability, death, or loss or damage to person or property incident to my child’s involvement or participation in this program, whether arising from the negligence of the releases or otherwise, to the fullest extent permitted by law. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, hereby indemnify and hold harmless all the above releases from any and all liabilities incident to my involvement or participation in this program, even if arising from their negligence, to the fullest extent permitted by law. 
 

PARKING
Parents must drop off and pick up on time. Practices are closed.

RULES & REGULATIONS
I/We willingly agree to comply with the program’s stated and customary terms and conditions for participation. I/We will furnish a Certified Birth Certificate and a copy of the current year’s report card of the above named applicant to the HCDP. I/We certify that the above named applicant is scholastically eligible to participate with HCDP Cheerleading. I/We agree to be financially responsible for any equipment to applicant other than the normal wear and breakage during
practice/ competitions and I/We will reimburse the HCDP for the loss and damage to said equipment. I/We as the parent of said candidate understand it is the responsibility of the parent, candidate, to comply with any and all Rules & Regulations of said HCDP. Any noncompliance with Rules & Regulations shall because for disciplinary action to be taken against said candidate, parent by HCDP. 
 

INSURANCE DISCLOSURE
The medical expense benefits of this plan are an “EXCESS” type benefit that picks up where other coverage’s leaves off. If the parent has any other Primary Coverage, whether individual, blanket or group coverage which provides benefits or services for, or by reason of, medical or dental care or treatment, then this plan, subject to the limits of the plan, will pay only the medical expenses not provided or reimbursable under your coverage. If the parent has no Primary
Insurance coverage then this plan, subject to the limitations and deductibles (if any) of the plan, will provide Insurance coverage. If the parent has coverage with any Pre-Paid Medical Plans, such as (but not limited to) Cigna, FHP, Aetna, Kaiser, Blue Cross, the injured person must be taken to the pre-paid medical facilities for treatment. All claims must be filed within 30 days of the injury/ accident. 
 

EMERGENCY MEDICAL RELEASE
I/We the parents of applicant give our permission for Any Emergency Treatment Necessary either at the practice or at competition. I/We authorize any hospital and/or physician to perform emergency treatments for any injuries resulting from any scheduled HCDP Cheerleading Functions League including the
supervised travel to and from said functions. 
 

PARENTS ACKNOWLEDGEMENT

I/We certify, that to the best of my/our knowledge, all of the above information is accurate and correct and that any false. Information may be cause for disqualification of the applicant. I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without an inducement.