Registration

The registration form is a 3 step process. You must complete all 3 steps to register!

Fields marked with an asterisk (*) are required

Practice Information

Practice will begin for all squads on Tuesday, August 9th on the CW Middle School Front Lawns. For 2nd - 7th graders, practice is T/W/TH 6 - 8 PM. For K - 1st graders, practice is T/TH 6 - 7 PM. Practice will move inside the Middle School on September 6th for all squads. When Competition practice begins, Competition will practice on T/W and Football practice will be on TH. The season goes to mid-November.

Grade at start of School Year in Fall 2022*

Please Note

The registration fee only covers 50% of the cost of participation. We rely upon fundraising to cover the remaining 50%. FOR THE 2022 SEASON, EACH FAMILY MUST SELL 1 Box of Hershey Candy Bars for $78.00 or choose the BUY-OUT Option for $40.00. If choosing the buy-out option payment is due now. The candy will be handed out at practice.

BUY OUT OPTION

Additional Fundraising Info

We are offering additional fundraising opportunities. After the required box of candy (or buy-out option if purchased), any additional boxes of candy sold will earn a family credit of $33. There is a 4 box limit. This credit will be refunded to you at the conclusion of the fundraiser in the form of a check. Select below how many extra boxes you would like to sell.

Extra Candy

$0 - no extra boxes of candy
$78 - 1 extra box of candy
$156 - 2 extra boxes of candy
$234 - 3 extra boxes of candy
$312 - 4 extra boxes of candy

Payment Method*

Cash
Check
PayPal

Total

$0.00

Payment Info

You have chosen PayPal as your payment method. Once you complete this entire registration form, you will forwarded to PayPal to enter your payment information and finalize your payment.

Payment Info

If paying by cash or check please remit payment to 7660 Lancaster Ave Myerstown PA 17067 within 10 days of registration in order for your child’s registration to be considered complete.

Cheerleader Info

Name*

First Last

Date of Birth*

School attending in Fall 2022*

Address*

Street Address Address Line 2 City ZIP Code

Home Phone*

Shirt Size (sizes run big)*

Emergency Contact Info

Guardian's Name*

First Last

Guardian's Contact Phone*

Guardian's Email*

Guardian 2 Name

First Last

Guardian 2 Contact Phone

Guardian 2 Email

Alternative Contact Name*

Alternative Contact Phone*

Alternative Contact Email*

Medical Info

Indicate specific medical allergies, chronic illnesses, or other medical conditions that coaches and medical personnel should be aware of:

Is your child allergic to any drugs? If so, what?

Does your child have any other allergies?

Does your child have or use any of the following? Check all that apply.

Asthma
Diabetes
Epilepsy
Epi-pen
Inhaler
Glasses
Contacts
Hearing Aids

Is your child on any medications? If so, what?

Does your child have any disabilities and/or special needs that we may need to be aware of?

Any additional medical information that may be helpful in a medical situation?

Parent or Guardian Authorization

In case of emergency - if family physician cannot be reached - I hereby authorize my child to be treated by Certified Emergency Personnel. (i.e. EMT/First Responder/E.R. Physician)

Physicians Name*

Physicians Phone*

Volunteer Opportunities

Conrad Weiser Little Scouts Cheerleading Association believes that the more families participate and volunteer the more fulfilling the experience is for their child. Volunteers are an essential part of our organization. Please take the time to support CWLSCA by volunteering your time! Place an X next to the volunteer opportunity that would be best suited for you and your family.

Volunteer

Please choose one or more

1 Coach
2 Assistant Coach
3 Board Member
4 Spirit Wear

PARENT / GUARDIAN REQUIRED AUTHORIZATION -- PLEASE "SIGN" BELOW

I, the undersigned, consent to allow my child to cheer with the Conrad Weiser Little Scouts Cheerleading Association. The CWLSCA is hereby released from any responsibility from any claim for damages, which my child or I may have because of mishap, accident, or injury in traveling to and from the playing field and while participating in any game, exhibition or practice. It is my understanding that the CWLSCA/CWCA only carries liability coverage. I understand that CWLSCA/CWCA does not carry medical insurance.

Authorized Parent or Guardian*

2022 Season Authorization Date*

PHOTO RELEASE

I hereby grant to CWLSCA and/or their legal representative, permission to use photographic portraits of my child in publications, forms, advertisements, newsletters, and websites. I waive any right I may have to approve the finished product. I hereby release CWLSCA and/or their representative, or those for whom they are acting, from any liability for any violation of any personal or proprietary right I may have in connection with the use of the above stated images.

Photo Release Authorization Name*

Photo Release Authorization Date*

PARENT CONSENT

I hereby grant CWLSCA and its volunteer coaches to obtain emergency medical care and to administer minor first aid procedures in the event of an emergency. I, the undersigned, consent to allow my child to cheer with the Conrad Weiser Little Scouts Cheerleading Association. The CWLSCA is hereby released from any responsibility from any claim for damages, which my child or I may have because of mishap, accident, or injury in traveling to and from the playing field and while participating in any game, exhibition or practice. It is my understanding that the CWLSCA/CWCA only carries liability coverage. I understand that CWLSCA/CWCA does not carry medical insurance.

Parent Consent Authorization Name*

Parent Consent Authorization Date*

Registration

CWLSCA 2022 Registration

Step 1 of 3

Practice Information

Please Note

Additional Fundraising Info

Payment Info

Payment Info

Cheerleader Info

Emergency Contact Info

Medical Info

Parent or Guardian Authorization

Volunteer Opportunities

PARENT / GUARDIAN REQUIRED AUTHORIZATION -- PLEASE "SIGN" BELOW

PHOTO RELEASE

PARENT CONSENT

CODE OF CONDUCT

INHERENT RISK NOTIFICATION