I, the undersigned parent or guardian, do hereby grant permission for my son/daughter, __________________________

49304 Frances Drive

Macomb Township, Michigan 48044

(586) 942-8386

(586)412-7035 fax

www.geocities.com/Michigan_Spirit

I, the undersigned parent or guardian, do hereby grant permission for my son/daughter, ___________________________, and hereinafter referred to as “participant” to participate in the Michigan Spirit LLC event. In order that the participant may receive the necessary medical treatment in the event of injury or illness, I hereby hold the event’s staff and representatives harmless in the exercise of this authority. I further acknowledge and understand that certain cheerleading activities have inherent risks and that cheerleading activity can be dangerous if the participant fails to follow established guidelines. I further agree to hold harmless Michigan Spirit LLC including its members, directors, contractors and staff for any injury or illness incurred by the participant during the course of the event. I hereby grant permission to Michigan Spirit LLC to use my child’s photograph on its website or in other official publications without further consideration, and I acknowledge the right of Michigan Spirit LLC to crop and treat the photograph at its discretion.

Signature of parent or guardian: ___________________ Date:______________

Address:________________________________________________

City: ______________________ State: ________ Zip: __________

Home phone: (___) ____-______

Emergency phone: (___) ___-_____

Signature of participant: _____________________________________

Participant’s date of birth: ____________________________________

Medications to which participant is allergic: ______________________

Medications to which participant is currently taking: _____________________

Pre-existing medical condition which may prevent participation:______________________________________________________