2015 WCYFC StarStravaganza Cheer Camp Formerly known as the Amelia Youth Athletic Club Taught by the Amelia High School Cheerleaders through WCYFC
Please join us at our annual Cheerleading Camp. Your daughter will learn the basics of cheer including
motions, jumps, chants and more! Our camp is open to ages 5-12 and you do not need to be a WCYFC
Cheerleader to participate. Our camp is held on Thursday and Friday night and then Saturday morning. On
Saturday awards will be given and the girls will perform the dance they have learned.
When: Thursday June 25th, Friday June 26th and Saturday June 27th
Time: Thursday and Friday 6:30-8:30 pm
Saturday 10:00am – 1:00pm
Where: Union Township Civic Center
Amphitheater
4350 Aicholtz Road
Cost: $45 (Due no later than May 25th)
•
This fee is for all 3 days and includes a t-shirt for each girl
Who: ALL YOUTH ages 5-12 (you do not have to be an WCYFC Cheerleader)
What: Come prepared to learn cheers, chants, jumps, motions
and have a ton of fun!!!! On the 3rd day awards will be given!!!!
~Snacks will be provided daily~
Please fill out attached registration/medical release and mail with payment no later
than May 25th, to:
Samantha Griffith
3398 Martin Drive
Amelia, Ohio 45102
Attn: 2015 Cheer Camp
***Please make checks payable to WCYFC***
Please contact Sam Griffith at [email protected] with any
questions
This event or activity is not sponsored or endorsed by West Clermont school district
Registration
Child’s Name_______________________________________ DOB_______________
Grade for Fall 2015_______________ T Shirt Size (YXS, YS, YM, YL, AS, AM or AL) ______________
Parent(s)/Guardian(s) __________________________________________________________
Phone number_______________________________________________________________
Email address ______________________________________@_______________________
Permission Signature______________________________________________ Date______________
Emergency Medical Authorization
Child’s Name________________________________School__________________Grade______
Address______________________________________________ Home Phone______________
Date of Birth____________________
Mother's Name_______________________________ Home Phone__________________
Work Phone_________________
Address (if different from child's) _____________________________________________________________________________
Father's Name________________________________ Home Phone__________________
Work Phone_________________
Address (if different from child's) ________________________________________________________________________
List in order person (s) who may be notified and to whom your child may be released if WCYFC Board Members cannot reach you:
Name
Relationship
Home Phone
Work/Cell Phone/Pager #
________________
_______________ _____________ ______________
________________
_______________ _____________ ______________
________________
_______________ _____________ ______________
________________
_______________ _____________ ______________
Facts concerning the child's medical history including allergies, medications and any physical impairment to which a physician should be
alerted _____________________________________________________________________________
_____________________________________________________________________________
Doctor to be called __________________________________Phone_______________
Dentist to be called __________________________________Phone_______________
Preferred Local Hospital___________________________________________________
Insurance Company_____________________ Member Name_______________________
Group#_______________________________ Member/ID #_________________________
Part 1 - TO GRANT CONSENT
In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment
deemed necessary by the above named doctor or in the event the designated preferred physician is not available, by another licensed
physician or dentist and (2) the transfer of the child to any hospital reasonably accessible. This authorization does not cover major surgery
unless the medical opinions of two other licensed physicians or dentists concurring in the necessity for such surgery are obtained prior to the
performance of such surgery.
Date_________________ Signature of parent/guardian______________________________
Part 2 - REFUSAL TO CONSENT
I do NOT give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, I
wish WCYFC Board Members to take the following action
_____________________________________________________________________________
Date_________________ Signature of parent/guardian_________________________________