Cheerleader Registration Form - BCF | Bim Cheer Federation

Full Name

Date of Birth

Address

Primary Phone Number

Alternative Phone Number

Any Allergies?

Any Disabilities?

Any Special Needs?

Need any medication?

Who is your Family Doctor?

Health Insurance Provider

Athlete Photo (Ping-Pong Picture)

Parent/Guardian Information:

If you are registering as an adult athlete, it is not required to fill out the form below. Parents who register on behalf of their adult children, please fill out below. For minors, it is MANDATORY to have at least one parent/guardian contact.

Parent/Guardian 1

Parent/Guardian 2

Primary Phone

Alternative Phone

Athlete History

Filling out information below will enable the BCF staff to better understand the progression of athletes when offering camps and clinics for the season.

Previous Performance Cheer experience

Yes I am a returning athlete (state program) Yes but with another program No

Previous Cheer experience

Yes I am a returning athlete (state program) Yes but with another program No

Highest Level Competed

Previous dance or gymnastics experience

Yes, I have been a member of a dance program Yes I have been a member of a gymnastics program Yes I have been a member of both a dance and gymnastics program No

Additional stunting experience (elaborate below for returning athletes)

Tumbling Experience (Elaborate below)

Select all that apply below:

Do you have a sibling(s) or additional children that will be registering as well?

Name of Participant

Address

City

Parish

Phone

Date of Birth

Name of Activity

Dates of Activity

MEDICAL INFORMATION AND RELEASE

Bim Cheer Federation requests the information below so that, in case of emergency, the School will have accurate information to enable the Coach or Teacher in charge to provide and/or seek appropriate treatment for you/ your child.

Participant Name:

Parent(s)/Legal Guardian(s) Name (if applicable):

Street Address:

Zip:

Parish:

Home Phone

Work Phone:

Name of Emergency Contact #1:

Home Phone

Work Phone

Cell Phone

Relationship

Name of Emergency Contact #2:

Home Phone

Work Phone

Cell Phone

Relationship

It is recommended that you consult with your physician prior to participating in this Activity. If you are uncertain about any preexisting medical conditions that may prohibit you/your child from participating safely in this Activity, it is your responsibility to consult with your own physician prior to participating in this Activity.

Do you have health/accident insurance? (circle one):

If yes, please indicate policy number, name and address of insurance company.

Company Name/Address

Policy#

PLEASE ENCLOSE A COPY OF THE FRONT AND BACK OF YOUR INSURANCE CARD WITH THIS FORM

Insurance Form Attachment

AUTHORIZATION FOR MEDICAL CARE

I consent to me/my child receiving medical attention in the event of illness or medical emergency while participating in this Activity. I acknowledge that BCF does not provide health and accident coverage to Activity participants and that I/we have adequate health insurance necessary to provide for and pay any medical costs that may be attendant as a result of any injury I/my child may sustain. I/we further agree to accept full responsibility for any and all expenses, including medical expenses that may derive from any injuries to my person that may occur during my participation in the Activity. By completing this form I represent and warrant that I have provided accurate and complete information to Bim Cheer Federation. I understand that the above medical information that I have disclosed will not be used by BCF to determine my/my child’s ability to participate safely in this Activity. I understand that, if I/my child choose(s) to participate in the Activity, I/my child do(es) so voluntarily and of my/my child’s own accord and the final decision regarding participation is solely my/our responsibility.

Print Student/Participant Name

Print Parent/Guardian Name

Date

Please Upload Proof of payment before Submitting This Form

Please read the following carefully, by clicking submit you accept the terms and conditions set forth in the BCF Bylaws & Code of Conduct for Members as well as our safety rules and standards and promise to abide by the rules and regulations set forth by the BCF. You promise to cooperate and follow the rules of the BCF.

Proof of Payment

Athlete Membership Registration 2025/2026

Registration Form