2015 Basketball Cheer/Dance Clinic

Date: Jan 24th
9:00 am- 12:00 pm

Location: Williams- Brice Kimbel Arena
Price: $30 Early Reg. Before Jan 5th
$40 Late Reg.

T-shirt and half time performance with CCU Cheer and Dance Teams.

Make checks payable to Coastal Cheerleading
Should you have any questions please contact Audra Scofield at 843.349.2867 or

Please complete the following form:

Participant's Name:    Age:

Participant's Name:    Age:

Participant's Name:    Age:

Address:   City:   

State:   Zip:


Parent's Name:

Home Phone:   Cell Phone:

T-shirt Request:

Please check the t-shirt size(s) you would like to reserve. Participant shirt cost is included in the registration fee. Additional shirts may be purchased for $10.00 each.

Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large

Check if there is more than one participant that needs a t-shrt.

Extra T-shirt sizes:

Camp and Clinic Release of Liability Form

I am aware that participating in cheerleading can be a dangerous activity involving MANY RISKS OF INJURY. I understand that the dangers and risk of participating in cheerleading include, but are not limited to, death, serious neck and spinal injuries and serious injury or impairment to other aspects of my body, general health or well being. Because of the dangers of participating in cheerleading, I recognize the importance of following the coach's instruction regarding playing techniques, training and team rules, and to obey such instructions. In consideration of Coastal Carolina University permitting me to participate in the Coastal Carolina University cheerleading clinic and to engage in all activities related to the cheerleading clinic. I hereby voluntarily assume all risks associated with participation and agree to exonerate and save harmless Coastal Carolina University, their agents, servants, and employees from any and all liability claims, causes of action or demands of any kind and nature whatsoever which may arise by or in connection with my participation in any activities related to Coastal Carolina Cheerleading.

I have carefully reviewed and voluntarily agree to the terms of this waiver and release of liability agreement.

Print Participant's Name:

Parent/Guardian Name Date:

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