A.L.A. Dance and Cheer Academy
Waiver Release Form
6601 Coffman Rd. Indianpolis, IN., 46268
A.L.A. Dance and Cheer Academy is a cheerleading/dance and floor gymnastics gym. It is important that as a
parent you understand the risks of ALL Star Cheerleading, dance and floor gymnastics. Our sport requires
head over rotations, stunts beyond a person high, lifting, fast movement that may require lifting own body
weight etc...This is NOT a side line cheerleading facility. With this in mind, you understand that your
child/ren might become injured while participating in this all star activity and understand that you release
A.L.A. Dance and Cheer Academy (A.K.A.: Alisha's Lil' Angels Dance and Cheer), it's owner's, instructors,
assistants, heirs of, students and their parents of ANY and ALL injuries either small or catastophic that may
occurr both on and off A.L.A. Premises (including, but not limited to: Competitions, Events, Gatherings both
group and personal, recitals etc..). We are also not responsible for accidents related with in the gym: falls,
object collisions, student collisions, mis use of property: mats, exercise equipment etc...As well, A.L.A.
Dance and Cheer Academy (A.K.A.: Alisha's Lil' Angels Dance and Cheer), Owners of, instructors, assistants
etc...are not liable for injuries even through negligence and by signing you relinquish your ablity to file suit.
You also release the 'Sports Zone of Indy 6601 Coffman Rd., it's owners, company and staff of any and all
monetary actions, claims or demands. By signing the release you also are agreeing that you have
insurance to cover your child/ren in case of emergency or if your child has a medical need that requires
attention, and if you don't have insurance at this time, you understand that by signing this release, you are
the sole care taker of any and all monetary claims, actions or demands that may arise from participating in
this activity. You also understand that A.L.A. Coaches will make any necessary decisions we feel are best
appropriate in the event your child/ren becomes injured, this includes transportation in the form of
ambulance etc..even if you did not feel the situation was as serious as we felt it to be. In which, you would
be responsible for any monetary demands that arise from this situation. A.L.A. Coaches can NOT administer
medications, inhalers, or even apply bandages- so please show your child how to properly use these items
if you plan to drop off and pick up. ALL students who have asthma should have an inhaler at practice! They
should have their inhalers in a zip lock bag with their name on the front. We also have many students and
may not always know this information at a given practice, PLEASE explain to your child/ren to let a coach
know if they are having trouble with their asthma etc...before it becomes a problem for them....I understand
the above stated:
Parent/Legal Gaurdian-Sole Responsible Party:
Printed Name:___________________________________________
Signature:__________________________________ Date:)___________________
Cheerleader Name 1:________________________________________________ B/Date:_________________
Age______
Cheerleader Name 2:________________________________________________ B/Date:_________________
Age______
Cheerleader Name 3:________________________________________________ B/Date:_________________
Age______
Parent Names: ________________________________ _________________________________
Address:______________________________________________________________________ Zip
Code______________
Email Address:___________________________________________________
Emergency #'s: Home___________________________ Work____________________________
Cell_______________________
1st Choice Hospital:_________________________________ Insurance Carrier:____________________________
MEDICAL RELEASE AND PARENT INFO ON BACK-PLEASE FILL OUT EVERYTHING LEGIBLY!
Are any of the members listed asthmatic? Y N Who:_____________________________________
Do any of the members listed have an allergy? Y N Who:____________________________________
What is the allergy?______________________________________________________________________
Do any of the members listed take a prescribed medication? Y N Who:___________________________
List any and all medications________________________________________________________________
Do any of the members have any condition you feel coaches NEED to know? Y N
Who:________________________________
What:__________________________________________________________________________________________
_______________________________________________________________________________________________
_____________________________________
Do any of the members listed have emotional or medical situations (such as A.D.D. Etc.. this will help
coaches to know how to best approach students who may have a medical challenge in this area, this way we
can be more understanding on how to handle their situation) Y N
Who:_______________________________
What:__________________________________________________________________________________________
___________________________________________________________. This information will remain
confidential!
Parent Information , Please initial you have read each para.
1.You understand that ALA can NOT be responsible for cheerleader's, dancers or gymnasts BEFORE and or
AFTER their scheduled practice times. Sports Zone does not want girls running the gym after their classes
are through etc.. (having a snack at the concession etc.. is fine) but, if it becomes a problem you will have
to wait through the entire class time with your child, even the older ones, please explain this to your child
before hand. X:)_____
2.Parent's MUST come to OUR office upstairs to check on accounts each 1st practice of each month (Before
the 8th) Neglecting to do so, may result in your child having to sit out of class if the account is past due.
X)_____
3.Sports Zone will allow you, your children and your member enrolled at ALA Cheer Academy to enter with
OUT paying door fee's (*unless you have another child already enrolled at the Sports Zone involved in
another sport that requires a door fee , basically, you are unable to use ALA as a reason not to pay the door
fee you would have had to anyway)...however, understand that the Sports Zone pays it's bills by running
their business this way and from memberships. They have politely asked me to keep my program, as I have
done the same- Separate from theirs, therefore- remind sons, brothers, dad's etc...that unless they plan to
purchase a membership they are unable to use the Sports Zone facility as recreation while waiting for their
cheerleader/s to be done (this excludes those who already have membership at Sports Zone). However,
you are able to use the concession area or remain upstairs within ALA area's. Thank you for your respect in
advance X)_____
4.You pledge to be a positive role model to ALA, your child and others. We are a cheer gym and coaches
work best in a positive environment and like to pass on the positive vibe to the children. Please don't
become involved in NEGATIVE talk about other children, their parents, coaches, office personnel etc...this
hurts feelings and causes destruction of our program, let's not be divided but be UNITED! X)_____
5.You understand that coaches must use discipline to keep team structure: this may include running laps,
conditioning group or solo, We must have your support that you understand this helps us gain positive
control of our classes: X)_____
6.Our sport is NOT for everyone, but we will run it as we deem necessary-if you have an issue please bring
it respectfully to the owner only by email please don't interrupt class time to discuss issues unless
extremely serious, thank you for this respect in advance. Understand that phone calls may take a couple of
days for me to get to (smile) I have 4 kids of my own and a business, I will get to it though- I promise! E mails
are always best... X)_____
ALA is Closed all Major Holidays and Holiday Weekends (no prorates allotted in such situations )
Christmas Break December 22nd-December 27th, Spring Break (due to many missing classes), Memorial
Weekend, Labor Day Weekend, Easter Day, 4th of July, New Years Eve and New Years Day.
ALA communicates through our website and/or by email!!! Please provide your email and check it often as
this is the only way I can virtually pass on needed information. If uncertain, always check our website. We
are NOT responsible for those who don't get information pertaining to the program if they did not provide
email information or check the web page.
In the case of weather alerts: WE run classes as much as possible...however, in the case of snow alerts,
weather alerts due to tornado's or chance of in the area, etc...classes may close with little or no warning_
THIS WILL BE LISTED ON THE WEBSITE AT LEAST 1hr PRIOR TO ALL CLASSES STARTING FOR THE DAY...IN THE
EVENT WE STAY OPEN COMPETITION MEMBERS ARE STILL REQUIRED TO ATTEND CLASS BUT MAY BE
EXCUSED AS A LATE ARRIVAL.
GET YOUR CALENDAR AND UPDATES AND REMINDERS ON LINE!!! ONCE I ENTER YOUR EMAIL ADDRESS INTO
MY ADDRESS LIST, I WILL SEND YOU A 'WEPLAY' REQUEST, SIGN UP AND ACCEPT ME AS A FRIEND...BY
DOING SO, YOU WILL AUTOMATICALLY receive UPDATES, REMINDERS, CAN CHAT and EVEN SEE ALA
PICTURES AND VIDEOS-THIS IS A PRIVATE SANCTION AND YOU MUST BE INVITED! LOOK FOR MY REQUEST
SOON!
ALA is Closed all Major Holidays and Holiday Weekends (no prorates allotted in such situations )
Christmas Break December 22nd-December 27th, Ping Break (due to many missing classes), Memorial
Weekend, Labor Day Weekend, Easter Day, 4th of July, New Years Eve and New Years Day.
ALA communicates through our website and/or by email!!! Please provide your email and check it often as
this is the only way I can virtually pass on needed information. If uncertain, always check our website. We
are NOT responsible for those who don't get information pertaining to the program if they did not provide
email information or check the web page.
In the case of weather alerts: WE run classes as much as possible...however, in the case of snow alerts,
weather alerts due to tornado's or chance of in the area, etc...classes may close with little or no warning_
THIS WILL BE LISTED ON THE WEBSITE AT LEAST 1hr PRIOR TO ALL CLASSES STARTING FOR THE DAY...IN THE
EVENT WE STAY OPEN COMPETITION MEMBERS ARE STILL REQUIRED TO ATTEND CLASS BUT MAY BE
EXCUSED AS A LATE ARRIVAL.
GET YOUR CALENDAR AND UPDATES AND REMINDERS ON LINE!!! ONCE I ENTER YOUR EMAIL ADDRESS INTO
MY ADDRESS LIST, I WILL SEND YOU A 'WEPLAY' REQUEST, SIGN UP AND ACCEPT ME AS A FRIEND...BY
DOING SO, YOU WILL AUTOMATICALLY receive UPDATES, REMINDERS, CAN CHAT and EVEN SEE ALA
PICTURES AND VIDEOS-THIS IS A PRIVATE SANCTION AND YOU MUST BE INVITED! LOOK FOR MY REQUEST
SOON!
 |
| |
 |
| |
 |
| |
 |