2016-2017 Cheer Agreement Packet
Welcome to ATA’s competitive cheerleading program. We are excited that
you have chosen to be a member of our ATA family! Our competitive
cheerleading program’s mission is to provide a safe environment for the team
members to grow together and develop cheer, dance, and tumbling skills. Every
member of our staff is United States All-Star Federation (USASF) certified in his
or her level of competitive cheer. We strive to provide a competitive atmosphere
for every athlete’s progression in all-star cheerleading. Our vision is to provide a
family oriented relationship with every member of our organization.
Please read and comply with the organizational policies set forth to join
our program. Once you have reviewed the agreement entirely, please fill it out
and turn it in to the front desk along with the additional attachments requested.
Incomplete packets will not be accepted. Please adhere to the rules set forth in
this packet to help make this season run as efficiently as possible. We are
expecting great things this season!
Cheers,
Matt Hodges
Reed Jackson
Owner
Owner
Checklist
All paperwork and fees must be turned in to the front desk before you will be allowed
to participate at the tryout clinic. Initial Entire Pakcet and fill out all forms and turn
in.
Also Attach:
Copy of Birth Certificate (New to ATA)
$50 Tryout Fee(By April 28th)
$75 Tryout Fee(After April 28th)
Page 2
Table of Contents
Section One
Tryout Information
Section Two
Costs- Annual & Monthly, Booster Club Fees & Payment Schedules
Section Three
Competition Schedule, Important Dates & Out of Town Stay
Section Four
Injuries
Section Five
Tardiness & Absences
Section Six
Conditioning
Section Seven
Dress Code
Section Eight
Parents & Relatives
Section Nine
Additional Information
Forms to Return
Absence Request Form (Goes to coach of team)
Student Registration Form
Release & Waiver of Liability
Tryout Form (attach photo we can keep)
Medical & Roster Form
Electronic Payment Authorization Form – ATA Tuition & Booster Club
Policies and Expectations Commitment Form
Parent Initials _________
Page 3
Section One – Tryout Information
Tryout Fee
The Tryout Fee is $50 if paid on or before Thursday, April 28th. Tryout fees turned in
Friday, April 29th or later will be $75. An ATA t-shirt is included in the tryout fee. If you
are a returning ATA cheerleader and bring in TWO NEW kids to tryouts, your monthly
tuition will be FREE (cannot be someone who has cheered for ATA or Icon before).
Tryout Clinic
Get a head start for tryouts! During this clinic, the instructors will be teaching specific
technique for tumbling, stunting, jumps, and motions that the athletes will use at
tryouts. All paperwork and fees must be turned in before you will be allowed to
participate at the tryout clinic. The tryout clinics are not mandatory and will be held at
the ATA location - 1505 Redi Road Cumming, Georgia.
Wednesday, May 11th
6:00-8:00pm 11 years old and under
Thursday, May 12th 7:00-9:00pm 12 years old and up
Tryouts
Saturday, May 14th:
Ages 11 and under will be from 10:00am - 12:00pm
Ages 12 and up will be from 1:00 pm - 3:00 pm
Tryouts are held at the ATA location - 1505 Redi Road Cumming, Georgia. If you cannot
make the tryout date, please e-mail [email protected] to schedule a private tryout.
Parent Meeting
Wednesday, May 18th the parent meeting will be held at 7:00pm. This is an informative
meeting to answer any questions about the season, and highly recommended that
parents attend.
Results
Saturday, May 21st the results and team practice times will be posted on the homepage
of ATA’s website (atacheer.com) by 10 p.m. Be prepared to practice on Sunday, May 22.
Team Meeting
All teams will have an informative meeting at the last 15 minutes of their first weekday
practice. This meeting will go over the coach’s expectations of your new team,
attendance/ tardy policy, and dress code policies. Parents and team members are
required to attend. Practice clothes payment will be due at this meeting for all teams
and we will size all cheerleaders on this day. Payment amount is $75 and made payable
to ATA Pro Shop. You can pay at the front desk via check, card, or cash.
Parent Initials _________
Page 4
Section Two – Cost/Annual and Monthly, Booster Club Fees, and Payment
Schedule
All fees are due on the scheduled dates listed below and are required to be paid
through our automatic debit system. The only exception is full payment for both
accounts on the first scheduled due date. These are separate accounts and we require
payments to the booster club and separate payments to the gym. The ATA tuition fees
are drafted on the 1st of each month. If the 1st of the month falls on a weekend, accounts
will be charged on the last business day of the week. The Booster Club fees are drafted
from our automatic draft on the 15th of each month.
If there are outstanding balances for ATA or the Booster Club, the athlete may
be removed from the team at the discretion of both ATA owners. Late charges will be
applied to accounts in delinquency. All balances due to the Booster Club must be paid
in full by December 15th, 2016 in order for your child to continue with the season.
Additional Booster Club fees may or may not be required, for example, make-up, bag,
team shirts, etc. The items listed under Payables to the Booster Club are required.
There will be NO refunds of any kind to anyone who quits or is asked to leave the
program. Anyone who leaves or is dismissed is responsible for all debts and legal fees.
If there are any problems financially, please speak with management immediately.
We will do our best to work with your situation, but please do not let it get out of
control. Outstanding balances could result in your child losing his or her spot on the
squad. There are numerous fundraisers you can participate in to help with the costs,
please utilize them. Fees for more than one athlete in a family are discounted for
monthly tuition charges only. Monthly gym fees run from May 2016 through April 2017.
Payable to ATA:
Fees
Annual Registration Fee
May 2016 Tuition (Prorated)
Monthly Gym Fee
-
-
-
One Child
$60
$75
$135
2+ Children
$100
$120
$220
Monthly gym fee includes two weekly 2 hour practices, tumble blocks, and gym
access anytime. Athletes are allowed to come to the gym anytime during gym
hours to tumble. If you would like to be placed in a class, you must call for
availability. Specialty classes such as stretching, stunt classes, etc. are extra and
are not included in this price.
Optional Classes
Fly Class (recommended for all flyers) $55 per month
Stretch Class (recommended for all beginner cheerleaders) $40 per month
Added Tumbling class for sibling - $45 per month
Parent Initials _________
Page 5
Payable to the Booster Club:
Payment Schedule:







New Athlete:
June 15th
July 15th
August 15th
September 15th
October 15th
November 15th
December 15th
Total
Returning Athletes:
$285
$285
$285
$285
$285
$285
$285
$220
$220
$220
$220
$220
$220
$220
$1,995
$1,540
Items included in Booster Payment
New Athletes: Uniform, Warm Up, Bow, Coaches Fees, Choreography/Music Fee, USASF
membership dues, Competition Fees
Returning Athletes: Bow, Coaches Fees, Choreography/Music Fee, USASF membership
dues, Competition Fees (If you are a returning athlete and need either a new uniform
or warm up, you will be subject to those additional costs).
Additional Fee: Makeup (amount TBD)
Optional Items not included in Booster:


Shoes $95
Backpack with Logo & Name $81
**If you are asked to be a crossover (meaning you compete on 2 teams) and agree,
please note that you will be responsible for all crossover fees associated with
competitions.
Parent Initials _________
Page 6
Section Three - Competition Schedule, Important Dates & Out of Town Stay
The competition schedule will be decided by the owners of ATA and will be sent out
to all teams, once it is finalized. We are only planning to travel to two out of town
competitions this season, with the possibility of a third. The rest of the competitions will
be held in the surrounding Atlanta area. We will begin competing within the first
weeks in December and end our season in March 2017, possibly April 2017. If a team
wins a bid to The Summit competition, located in Orlando, Florida, on May 4-7, 2017,
the owners of ATA will decide whether or not to participate. Level five teams that are
World Bid eligible and receive a World Bid will be attending the World’s Competition
on April 29-May 1, 2017. ATA teams that are Worlds Bid Eligible may attend additional
or separate competitions to compete to receive a Worlds Bid.
Not all of the ATA teams will be attending the same competitions throughout the
season. Some teams may travel to more out-of-town competitions than others. We
reserve the right to modify the schedule during the season as needed. We will be
sending the competition schedule out in the early part of the summer via email.
Notable Dates:




















May 11th & 12th
May 14th
May 18th
May 21st
May 22nd
May 23rd
May 28th – 30th
June 3rd
July 2nd – July 10th
July 11th-14th
August 4th
August 7th
Sept 4th- 5th
Sept 26th – Sept 30th
October ???
Nov 21st – 26th
Nov 30th
Dec. 21st – Jan 3rd
Feb. 20th
April 3rd – 7th
Parent Initials _________
Tryout Clinics
Tryouts
Gym-wide Parent Meeting 7 p.m.
Tryout Results (by midnight on ATA Website)
First Practice
Weekday Practices Begin (Parent Meeting last 15 minutes)
No Practice (Memorial Day Weekend)
First day of Friday practice
No Practice – Gym Closed (Fourth of July)
*Choreography
First day of School
First Sunday Practice
No Practice (Labor Day)
No Practice – Fall Break
Choreography for Dances (TBD)
Thanksgiving Break – Gym Closed
ATA Showcase
Christmas Break – Gym Closed
Presidents Day – Gym Closed
Spring Break – Gym Closed
Page 7
All Cheerleaders will use the same accommodations at all out of town competitions.
DUE TO CONTRACT AND “STAY TO PLAY” OBLIGATIONS, ALL ATHLETES ARE
REQUIRED TO STAY AT TEAM HOTELS. There must be a parent in every room, no
exceptions. Each cheerleader must have a chaperone at every competition. It is not your
coach, Team Mom, or ATA staff’s responsibility to be your child’s chaperone. We will
send out rooming blocks as the season begins and you will be responsible for booking
your own room and paying the hotel directly for your accommodations.
Section Four – Injuries




Parents need to understand that cheerleading is a highly competitive and
dangerous sport. Stunts and tumbling can lead to injury. These include, but are not
limited to: bruises, pulled and strained muscles, torn or strained ligaments, broken
bones, dislocations, paralysis, or even death.
We at ATA will do everything in our power to limit these injuries from occurring;
however, we cannot prevent them all from happening.
If your child is injured, we will do everything necessary to ensure your child’s wellbeing.
Please fill out the medical information as accurately as possible for our emergency
purposes and notify the front desk of any changes.
Section Five - Tardiness & Absences
Please understand you are a part of a team that requires a time and attendance
commitment, as the other team members are relying on your attendance. Please arrive
early to all team commitments and be prepared to begin at the scheduled time.






Tardiness is defined by 10 minutes late to practice or leaving practice early.
Excessive tardiness and absences will result in dismissal from the team.
Tardiness and absences to a competition will not be tolerated and will result in
immediate dismissal from the program. You are required to arrive at the
competition at the designated time given to you by your coach. All times are given
to you for a reason, so please be on time. If you are deemed unreliable and cannot
make it to the competitions at your scheduled time you may be asked to leave.
Please plan vacations and activities around scheduled gym breaks.
In this packet, there is an Absence Request Form. Please fill this form out as soon as
you know your schedule and turn it in to the front desk. This form does not make
the absence excused. Excessive absences need to be addressed with the coach. We
need this form filled out so we can plan our practices accordingly.
Each team will be assigned other teams to watch at competitions, and are
encouraged to stay all day.
Parent Initials _________
Page 8




If your child is sick and cannot attend practice, please present a doctors excuse.
Team members are not allowed to miss practices or extra practices the week prior to
a competition unless there is a death in the family. If a team member misses any
practices the week prior to a competition, that athlete may be worked out of the
routine and may not be allowed to compete that weekend.
If there are any scheduling conflicts the week prior to a competition, please let the
coach know in advance. We will do our best to work around your schedule
regarding extra practices, but please be aware that we all make sacrifices for the
benefit of the team.
All parents and athletes need to understand that “having homework” is not an
excuse to miss practice. Please utilize time management skills.
Section Six – Conditioning


Competitive cheerleading is very strenuous and athletes in our program are
expected to be in top physical shape. This includes flexibility, strength, and
endurance. If a team member is lacking in an area, they may be required to take a
flexibility class or any other class offered we feel they need. These classes are not
included in the normal gym fee and will be drafted from the information listed in
our automatic debit system.
All team members are expected to take care of their bodies. This means no drugs,
no alcohol, and no tobacco. If anyone is caught drinking, smoking, using drugs, or if
there is an eating disorder or other major health issue, he or she will be expected to
take the necessary steps to quit. We will, of course, help in any way we can, but
persistence of such acts will result in dismissal from the ATA program.
Section Seven - Dress Code
Please understand you are representing yourself, your team, and the ATA program
wherever you go. Please present yourself in such a way.




The coach of your team will set a dress code for practices. You are required to follow
this dress code, no exceptions. Failure to follow the designated dress code will result
in additional conditioning for your child.
Hair needs to remain in a ponytail with a bow for practice.
Fingernails must be kept short. Fake nails are not allowed at practice or
competitions. Please remove them prior to each of these events.
NO JEWELRY at ATA Events or Practices. Jewelry can cause injury to yourself or
others.
Parent Initials _________
Page 9
Competition Dress Code:


Arrive to competitions with hair complete with bow in, and makeup is finished. You
must have your uniform top on. You can only wear your white cheer shoes (white no
show socks), no other shoes are allowed at any time. Arriving at competitions any
other way than stated is prohibited. If you are new this season or have not
purchased a warm-up, you are required to do so.
Awards Attire: All ATA athletes must wear the full warm-up attire during the
competition awards with the jacket zipped up.
Section Eight - Parents & Relatives
We are all here for a common goal and failure to comply with the below guidelines may
result in you or another family member causing your child’s dismissal from the ATA
program.






It is the parent’s responsibility to know what is going on with your ATA member’s
team at all times. Please check the website, your e-mail, or with the team mom or
coach to keep updated on the latest happenings.
Please do not gossip about other children, your team, coaches or any other team.
This will not be tolerated! NO GOSSIP ON ANY SOCIAL MEDIA NETWORK
(Facebook, Twitter, Instagram, etc.) Team members, parents, etc. are not allowed to
make their own facebook or twitter page for the team. If applicable, the gym will
create these.
If gossip at ATA or an affiliated event becomes an issue, then parents will be asked
to leave and it will be up to the coaching staff and owner on whether to close
practices.
There will be no yelling onto the floor at a team member or coach while practices
are in session.
Please feel free to speak to the coach about anything; just remember to do it at the
appropriate time and in the appropriate manner. For example, approaching a
coach in the middle of a practice or class is not an appropriate time.
If you are not a cheerleader or a coach you are not allowed beyond the parent room
and in the practice area of the gym unless directed to do so by a coach.
Section Nine - Additional Information
Please remember you are not just a part of a team, you are a part of a gym.



Main communication from the team moms, owners, and coaches will be through email, text messaging (group me), and website updates. Please regularly ensure you
are a part of receiving these communications.
ATA staff reserves the right to move a team member between levels.
ATA staff selects teams to be the most competitive at each level.
Parent Initials _________
Page 10



















There are no assigned spots in routines. Adjustments will be made throughout the
season based on the coach’s discretion.
If the coach feels your daughter or son should be a flyer, they will. As a parent, you
do not decide this.
The roster may change for the World’s or Summit competition to provide the best
ATA has to offer. The coaches reserve the right to replace an athlete for any reason.
If there are outstanding balances on the ATA or ATA Booster Club Account, an
athlete may be removed from the team.
If you or your child has a pressing issue with an ATA affiliated staff member or team
member, please speak directly with Matt Hodges or Reed Jackson and not another
parent, child, or staff member.
All team and routine decisions are left up to the discretion of the coach and owners.
If there is a problem with anything, please address the appropriate ATA member to
initiate a resolution.
No gossip about any other team, whether it be school or allstar. NO gossip about
any other team members.
No profanity, abusive language, or inappropriate gestures at any ATA affiliated
event or location.
During practice, your opinion (team member or parent) does not count. If there is a
problem, please bring it to a staff member’s attention after practice. We reserve the
right to close practices to parents at any time we choose.
Every year, we go through losses and additions to teams. The dismissal or addition
of a member is at the owner’s discretion.
Practices may be changed and/or added throughout the season and team members
are required to attend. Please expect a Friday practice the week before any
competition.
Anyone threatening to quit, or pull his/her child from a team will be dismissed from
the program immediately. Fees will not be refunded.
Practices and competitions are not to be used as punishment for your child’s actions
outside of the gym. So, not allowing your child to come to practice or competition
for punishment is inexcusable. You not only punish your child, but every other child
and parent on that team.
ATA Members are NOT ALLOWED to train at another facility during the allstar
season (May – April). If you are caught doing so, it may be grounds for dismissal
from the ATA Program.
Each cheerleader must have a chaperone at every competition. It is not your coach’s
responsibility to be your child’s chaperone.
All cheerleaders and ATA families are required to show good sportsmanship and
represent themselves in a respectable manner.
If there is a disciplinary problem or unacceptable behavior, especially at a
competition, this could be grounds for your child’s dismissal from the team.
There will be no arguing or questioning the coaching staff’s decisions at any ATA
affiliated event.
We are allowed to change, add, or subtract any rule in this packet at any time.
Parent Initials _________
Page 11
ABSENCE REQUEST FORM
ATA 2016-2017
***Turn this form directly in to the coach of your daughter or son’s team.
Date/Dates to be Absent
Reason for Absence
I,
, am requesting to be absent from practice on
the date above. I know that missing practice places complications and difficulties on
the whole team. I also understand that an unexcused absence or continual excused
absences can result in being placed in an alternate position or removal from the squad.
Cheerleader Signature _________________________
Date
Parent’s Signature_____________________________
Date
Parent Initials _________
Page 12
General Information
Student Name
Date of Birth
Street Address
Mother Name
Father Name
Mother Cell (Number called
first)
Father Cell
Mother Email
Father Email
EMERGENCY INFORMATION
I hereby authorize A-Towne Allstars staff or anyone they designate to treat my son/daughter
_________________________(athletes name) for injuries or illness that may occur while at a gym function. I authorize
necessary medical treatment to any hospital designated by A-Towne Allstars or to their designate. It is understood
the parents or their agents ill be called upon to give additional authorization if advanced treatments (MRI, lab tests,
surgical procedures, etc...) are necessary. I am aware as a parent of the above participant that I will be responsible
for providing proper insurance information to A-Towne Allstars prior to participation in any A-Towne Allstars
programs.
INSURANCE
Insurance Carrier _________________________________________
Policy Number _______________ Group Number _____________________
Family Physician ___________________ Phone ______________
Emergency Contact __________________Relationship ______________Phone ______________
Parent Initials _________
Page 13
Release & Waiver of Liability, Assumption of Risk and Indemnity Agreement (“Agreement”)
In consideration of participating in the cheerleading classes, including but not limited to, tumble classes, stunt classes, dance classes,
private lessons, and competitions, I represent that I understand the nature of this Activity and that I am qualified, in good health,
and in proper physical condition to participate in such Activity. I acknowledge that if I believe event conditions are unsafe, I will
immediately discontinue participation in the Activity. I fully understand that this Activity involves risk of serious bodily injury,
including permanent disability, paralysis and death, which may be cause by my own actions, or inactions, those of others
participating in the event, the conditions in which the event takes place, or the negligence of the “releases” name below, and that
there may be other risks either not known to me or not readily foreseeable at this time and I fully accept and assume all such risks
and all responsibility for losses, costs, and damages I incur as a result of my participations in the Activity.
I hereby release, discharge, and covenant not to sue ATA, its respective administrators, directors, agents, officers, volunteers, and
employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the activity
takes place, (each considered one of the “RELEASEES” herein) from all liability claims, demands, losses, or damages on my account
caused or alleged to be caused in whole or in part by the negligence of the “releases” or otherwise, including negligent rescue
operations, and I further agree that if, despite this release, waiver of liability, and assumption of risks I, or anyone on my behalf,
makes a claim against any of the Releasees, I will indemnify, save, and hold harmless, each of the releases from any loss, liability,
damage, or cost which any may incur as a result of the such claim. We agree to pay ATA those fees charged for any class or team
based activity. These fees will be due the first class of each month. Payment made after 15 days past the due date will accrue a
$25.00 late fee, and will be applied to all unpaid accounts. There is a $25.00 fee for all returned checks. I have read this RELEASE
AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMITY AGREEMENT, understand that I have given up substantial
rights by signing it and have signed it freely and without any inducement or assurance or any nature and intend it be a complete
and unconditional release of all liability to the greatest extend allowed by law and agree that if any portion of this agreement is
held to be invalid the balance, notwithstanding, shall continue in full force and effect.
Parental Consent
AND I, the minor’s and/or legal guardian, understand the nature of the above referenced activities and the minor’s experience and
capabilities and believe the minor to be qualified to participate in such activity. I hereby release, discharge, covenant not to sue
and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees from all liability, claims, demands, losses, or
damages on the minor’s account caused or alleged to have been caused in whole or in part by the negligence of the Releasees or
otherwise, including negligent rescue operations, and further agree that if, despite the release, I, the minor, or anyone on the
minor’s behalf makes a claim against any of the above Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the
Releasees from any litigation expenses, attorney fees, loss of liability, damage, or cost any Releasee may incur as the result of any
such claim.
Medical Release
I grant Releasees permission to provide medical treatment for any injuries incurred during participation in the Activity, and do
hereby release and hold harmless each of the Releasees from any claims, loss, liability, damage, or cost arising from such treatment.
I hereby authorize ATA staff or anyone they designate to treat my son/daughter for injuries or illness that may occur while at a gym
function. I authorize necessary medical treatment to any hospital designated by ATA or to their designate. It is understood the
parents or their agents will be called upon to give additional authorization if advanced treatments (MRI, lab tests, surgical
procedures, etc...) are necessary. I am aware as a parent of the above participant that I will be responsible for providing proper
insurance information to ATA prior to participation in any ATA programs.
Photography Release
I grant Releasees permission to use photographs taken during participation in the Activity, in a manner permitted by law, in
printed publications, including, but not limited to, advertisements, both paper and electronic, event flyers, and our website located
at www.atacheer.com, without notification not compensation of any kind.
Printed Name of Participant ____________________________
Signature of Parent/Guardian _________________________________________ Date _____________________
Parent Initials _________
Page 14
TRYOUT FORM
2016-2017
Name
Age as of 8/31/2016
Grade in 2016-2017
Date of Birth
Emergency Number
[Attach Photo Here
Tryout Number
Parent Initials _________
Page 15
MEDICAL INFORMATION & ROSTER FORM
Student Name
Date of Birth
Street Address
Mother Name
Father Name
Mother Cell (Number called
first)
Father Cell
Mother Email
Father Email
Insurance Carrier
Insurance Group Number
Insurance Member ID
Allergies
Physician & Physician
Phone
Cheerleader School
Previous Injuries
Cheerleader Email & Cell
Number
T-shirt: Youth S, Youth M, Youth L, Youth XL/Adult XS, Adult S, Adult M, Adult L
Jacket: Youth S, Youth M, Youth L, Youth XL/Adult XS, Adult S, Adult M, Adult L
Shorts: Youth S, Youth M, Youth L, Youth XL/Adult XS, Adult S, Adult M, Adult L
Parent Initials _________
Page 16
GYM FEES ELECTRONIC PAYMENT FORM
Customer Name
Email Address
Best Phone Number
Billing Address
Credit/Debit Card Authorization
Card Type (Visa, MC,
Discover, Amex)
Card Number
Card Expiration
Date
Card Security Code
(3 or 4 Digit Code)
___$135 monthly for 1 child or $220 monthly for 2 children__
Payment Amount
PAYMENT AGREEMENT
I hereby authorize ATA to initiate debit or credit entries to my Checking/Savings/Credit Card Debit Card Account indicated
above at the depository financial institution named above (hereafter called Depository) , or to the card account listed
above; and to debit or credit the same such amount to such account. If this item is dishonored, I authorize an additional
returned check/refusal of charges fee of $25.00(or legal limit) to be charged to this account. I understand and accept that
payment for services rendered by ATA is due on the 1st of any given month for services rendered for the following month
while enrolled in the program. The above listed method of payment shall be charged for said months on the 1 st of every
month for the following month's charges. If the 1st of the month falls on a weekend, accounts will be charged on the last
business day of the week. I understand that services may be denied or interrupted by ATA due to the refusal or denial of
charges made on this account for any reason. The term of this agreement can only be discontinued by directing written
notification to ATA by the 15th of the month to stop charges for the following month. I represent and warrant that I am
authorized to execute this payment authorization for the purpose of securing Services provided by ATA. I understand there
is a late fee of $25 that I am responsible for if I do not pay by the 15th of each month. I indemnify and hold the Merchant
Service Provider, the Depository, the company holding the above mentioned card account, and ATA harmless from damage,
loss, or claim resulting from all authorized actions here under.
____________________________________
Consumer Name (Printed)
Parent Initials _________
_________________________________
Authorized Customer Signature
__________
Date
Page 17
Booster Electronic Payment Form
I hereby authorize Icon Allstars Booster Club Inc. to initiate debits to my Credit Card
Account indicated below for the amounts and frequencies indicated below.
Amount to be Debited (Circle ONE)
1 Returning Athlete $1540 (7 payments of $220)
1 New Athlete $1995 (7 payments of $285)
2 Returning Athletes (7 payments of $440)
2 New Athletes (7 payments of $570)
1 Returning Athlete (paying in FULL $1540)*
1 New Athlete (paying in FULL $1995)*
*If choosing to pay in FULL, payment is due on June 15th, 2016
Credit/Debit Card Authorization
Card Type (Visa, MC,
Discover) *We do NOT
take Amex
Card Number
Card Expiration
Date
Card Security Code
(3 or 4 Digit Code)
I hereby authorize Icon Allstars Booster Club to initiate debit or credit entries to my
Checking/Savings/Credit Card Debit Card Account indicated above at the depository financial institution
named above (hereafter called Depository) , or to the card account listed above; and to debit or credit
the same such amount to such account. If this item is dishonored, I authorize an additional returned
check/refusal of charges fee of $25.00(or legal limit) to be charged to this account. The above listed
method of payment shall be charged for said months on the 15 th of every month. I understand there is a
late fee of $25 that I am responsible for if I do not pay by the 30 th of each month. I indemnify and hold
the Merchant Service Provider, the Depository, the company holding the above mentioned card account,
ATA, and Icon Allstars Booster Club harmless from damage, loss, or claim resulting from all authorized
actions here under.
Name Printed: ______________________ Signature: _________________________ Date: ___________
Parent Initials _________
Page 18
POLICIES & EXPECTATIONS COMMITMENT FORM
I have read and fully understand all codes, rules, expectations, and
monetary commitments in this competition agreement commitment
packet. I understand that I am entering into the ATA Cheerleading
program of my own free will. I understand what is expected of me as a
parent or team member. I will conduct myself in a sportsmanlike manner
and uphold the standards that are expected of me as a member of the ATA
program.
Cheerleader Name:
______________________________
Cheerleader Signature: ______________________________
Date: _________________
Guardian Name:
_________________________________
Guardian Signature:
_________________________________
Date: _________________
Parent Initials _________