Hillsborough Cheer, Dance & Gymnastics Waiver

Parents First Name *

Parents Last Name *

Address

Street Address *

City *

State *

Postal Code *

Phone *

Email *

Athlete Name *

Athlete Date of Birth *

Reason for Completing Waiver

MEDICAL AUTHORIZATION AND LIABILITY RELEASE

(Insert Medical Authorization and Liability Release Here)

I agree to the medical release as outlined above

Today's Date