Name of Child:

Age:

Grade: 

School: 

Parent/Guardian Name:

Home phone:

Cell phone:

Address:

City:   State:

Zip:  

Email Address:

Child's T-shirt Size: (Check One)
Youth Small
Youth Medium
Youth Large
Youth XL
Adult Small
Adult Medium
Adult Large
Adult XL           

T-shirts can only be guaranteed if registered by January 3, 2013.

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I, , am allowing my child,  to participate in the Tech Youth Spirit Clinic. I understand that in any athletic activity, including cheerleading and dance, accidents can happen. In the event my child is injured, I release Tech Youth Spirit Clinic, the clinic Director and Staff, and the University from any and all liability. I understand that my child will be taught in safe progressions, however there is always a risk involved with this type of activity.

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