Hurry and Register- Space is Limited
MAIL TO or CARRY TO:
East Duplin HS Cheerleaders: Attn: Emily Sandlin/Kristen Kapfer, Cheer Coach
394 N NC Hwy 111, NC 28518
PANTHER CHEER CAMP – PreK – 6th Grade
Registration Form
Thursday, September 10, 2015 3:30-6:30pm
Please fill out this form completely and mail it in with your cash or check in the
amount of $35 no later than September 1, 2015 to guarantee a spot.
Please make checks payable to East Duplin Boosters.
PLEASE PRINT ALL INFORMATION:
If you are registering more than one camper, please use separate registration forms.
Camper’s Last Name:__________________First Name:_______________MI:___
Age:____ Grade:________ School:____________
Address:__________________________________________________
City:______________________ State:_________ Zip:_____________
Parent/Guardian
Name(s):_____________________________________________________________
Address:______________________________________________________________
City:_____________________________ State:___________ Zip:________________
Email:_______________________________
Home Phone:____________________________ Cell Phone:____________________
Alternate Contact Information (In case of emergency and parent cannot be
reached.)
Alternate Contact’s Name________________________________________________
Relationship _____________________ Cell Phone___________________________
T-Shirt Size (Please circle your child’s size):
Youth Sm (6-8)
Adult Sm
Y Med (10-12)
Adult Med
Y Lg (14-16)
Adult Lg
YES I would like my child’s picture taken with the Panther Cheerleaders. I have
included $5 for a color photo.
NO I would not like my child’s picture taken with the Panther Cheerleaders.
How did you find out about the Panther Cheer Camp?________________________
*Your cheerleader will receive a snack, water, and ribbon upon arrival. He/she will
get in FREE to the James Kenan football game Friday, September 11, 2015 with
his/her shirt from camp. We will perform at halftime (approximately 8:30.)*
Hurry and Register- Space is Limited
MAIL TO or CARRY TO:
East Duplin HS Cheerleaders: Attn: Emily Sandlin/Kristen Kapfer, Cheer Coach
394 N NC Hwy 111, NC 28518
Liability Waiver
I understand that my child, (child’s name __________________________)
will be participating in the East Duplin High School Cheer Camp on
_________________. Since this is a voluntary program, I will not hold the
school, staff members, or cheer team members liable for any accidental
injury, which may occur. In case of a medical emergency, I do give consent
for my child to be treated at the nearest emergency room.
Please list any allergies or health concerns we should be made aware of for
your child, and any required special medications or
treatments:____________________________________________________
Is there anything else we should know about your
child?________________________________________________________
_____________________________________________________________
Parent/Guardian Signature________________________________________
Date____________________
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
For Office Use Only:
Payment:
Cash ___________
Check #______________
Picture:
YES
NO
Tshirt:
YS
YM
YL
AS
AM
Pd $5
AL