Forms Fierce Waiver Topeka Enrollment Fierce Waiver Please enable JavaScript in your browser to complete this form.Child's Name *FirstLastAllergies or MedicationsAllergiesMedications(hereinafter “athlete(s)”) is in good physical health, and there are no medical conditions that would limit his/her participation in class except as follows (Please list for each student)List AllergiesList MedicationsInsurance Company *Policy Number *Preferred Hospital *Release Waiver *AgreeRELEASE WAIVER I, the undersigned intend that there shall be no personal liability by the members, directors, or employees of Fierce Training Facility for any claims, obligations, or demands of any kind or nature whatever. I understand that participation in cheerleading activities involves a reasonable assumption of risk. I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis, and death, as well as other damages and losses associated with the participation of cheerleading activities and events. I give permission to Fierce Training Facility and/or appropriate medical facility to take whatever emergency measures as judged necessary for the care and protection of the athlete(s) while under the supervision of Fierce Training Facility. In case of emergency, I understand that the athlete(s) will be transported at my expense. It is my understanding that in some medical situations, the staff will need to contact the local emergency resource before the guardians, the athlete(s) physician, and/or other adults acting on the guardian’s behalf. Fierce Training Facility is not responsible for any personal items brought into the facility.USE OF PHOTOGRAPHS, VIDEOTAPES, AND RECORDINGS *AgreeI hereby acknowledge that I am either the parent or legal guardian of the athlete(s); I authorize Fierce Training Facility to retain the right to use any photographs or video recordingsEmail *Signature *Clear SignatureSubmit Topeka Enrollment Please enable JavaScript in your browser to complete this form.Monthly Membership TypeTots/Youth – $ 39.00Jr Level 1 – $ 49.00Session 1-4/5 – $ 49.00Athlete Membership Information *FirstLastM/FDOB *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmergency Contact *FirstLastEmail *Phone *RelationshipFamily Member (Only if adding additional athletes)Add Additional AthleteAthlete Membership InformationFirstLastM/FDOBAthlete Membership InformationFirstLastM/FDOBConditions of Membership *AgreeApplicant understands that if they wish to terminate their membership, it must be done by the 1st of the previous month. For example: you must cancel by December 1 if you want your draft to stop in January. If notification is not received by the appropriate time, you will be charged for the ensuing month. I understand it is my responsibility to notify Fierce Training Facility of any changes to my address, phone number, general information and bank account information (if using monthly EFT.) I, the undersigned intend that there shall be no personal liability by the members, directors, or employees of Fierce Training Facility for any claims, obligations, or demands of any kind or nature whatever. I understand that participation in cheerleading activities involves a reasonable assumption of risk. I am fully aware of and appreciate the risks, including risk of catastrophic injury, paralysis, and death, as well as other damages and losses associated with the participation of cheerleading activities and events. I give permission to Fierce Training Facility and/or appropriate medical facility to take whatever emergency measures as judged necessary for the care and protection of the athlete(s) while under the supervision of Fierce Training Facility. In case of emergency, I understand that the athlete(s) will be transported at my expense. It is my understanding that in some medical situations, the staff will need to contact the local emergency resource before the guardians, the athlete(s) physician, and/or other adults acting on the guardian’s behalf. Fierce Training Facility is not responsible for any personal items brought into the facility. I hereby acknowledge that I am either the parent or legal guardian of the athlete(s); I authorize Fierce Training Facility to retain the right to use any photographs or videoPayment info will be taken at the gymSignature *Clear SignatureSubmit
