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    Pa Part Waiver 08

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    vickiecavanagh
    No one CAN PARTICIPATE WITHOUT this FORM, AND it must be MAILED in to the elite office no later than friday, OCTOBER 31, 2008. Make sure that this form is signed by your parent or guardian.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Pa Part Waiver 08

    Uploaded by

    vickiecavanagh
    25 views1 page
    No one CAN PARTICIPATE WITHOUT this FORM, AND it must be MAILED in to the elite office no later than friday, OCTOBER 31, 2008. Make sure that this form is signed by your parent or guardian.

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    © Attribution Non-Commercial (BY-NC)

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    No one CAN PARTICIPATE WITHOUT this FORM, AND it must be MAILED in to the elite office no later than friday, OCTOBER 31, 2008. Make sure that this form is signed by your parent or guardian.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    25 views1 page

    Pa Part Waiver 08

    Uploaded by

    vickiecavanagh
    No one CAN PARTICIPATE WITHOUT this FORM, AND it must be MAILED in to the elite office no later than friday, OCTOBER 31, 2008. Make sure that this form is signed by your parent or guardian.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    The Official Pennsylvania Battle in the Burgh™

    Cheerleading & Dance And/Or Open Championships


    Championships™ By Elite
    Please complete all sections below. Make sure that this form is signed by your parent or guardian. We
    require each person attending the competition to complete this form. NO ONE CAN PARTICIPATE
    WITHOUT THIS FORM, AND IT MUST BE MAILED IN TO THE ELITE OFFICE NO LATER
    THAN FRIDAY, OCTOBER 31, 2008.

    PARTICIPANT INFORMATION

    _________________________________________ _________________________________________
    Participant’s Name Competition Location & Date

    _________________________________________ _________________________________________
    Home Address Participant’s School/Organization Name

    _________________________________________ _________________________________________
    City State Zip Participant’s Grade

    _________________________________________ _________________________________________
    Participant’s Date of Birth Parent’s Daytime Phone
    Father Mother Guardian

    MEDICAL & INSURANCE INFORMATION

    Insurance List Any Medications Currently Taking:


    Company_________________________________
    ___________________________________________

    Address___________________________________ List Allergies:


    ___________________________________________
    ___________________________________________
    List Allergies to Medications:

    Medical ___________________________________________
    Insurance Policy #_________________________ MY CHILD HAS NO MEDICAL OR
    HEALTH PROBLEMS THAT WOULD
    PROHIBIT HE/SHE FROM
    Family
    PARTICIPATING IN THE
    Physician_________________________________ AFOREMENTIONED EVENTS:
    ___________________________________________
    Phone ( )__________________________ Parent or Guardian Signature

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