Tryout Package 1010
The tryout information for the next season is contained in the following PDF.
Gym Waiver
In order for a child to participate in gym activities we require the following form to be completed
by a parent or guardian.
Click here to download the gym waiver PDF
If for some reason that doesn't work please copy and paste the form below:
Polk Aces Competitive Cheerleading
Gym Release Form
Waiver & Medical Release Form
Childs Name __________________________ DOB __________Grade_________
AGE AS OF MAY 31st 2009______________
Parent/Guardian’s Name ______________________________________________
Address ____________________________________________________________
Day Phone ( )_____ -______ Evening Ph ( )_____-_____ Cell ( )____-______
Email Address_______________________________________________________
Emergency Contact _____________________________Ph#___________________
Insurance:________________ Policy:_____________ Ph#____________________
Medications Currently prescribed (if any)__________________________________
Allergies _____________Medical Conditions______________________________
If not covered under any insurance policy, please be aware that any and all bills will be sent
directly to the above listed parent or guardian.
By permitting my child to participate in the Polk County ACES cheer/tumble program, I
understand and acknowledge that participation in cheerleading involves a certain degree of
risk. I hereby release Polk County ACES and all associates or representatives, owners,
employees, jointly and separately from any and all personal injury claims arising through or
from participation in activities as a student of Polk County Aces. Polk County Aces highly
recommends a physician physical prior to participation in cheerleading, tumbling or dance for
your child’s benefit.
Furthermore, I/we authorize Polk County ACES or it’s representatives to procure, at my/our
expense any medical care reasonable required by a foresaid child during his/her visit at the
hospitals or facilities chosen by Polk County Aces. I/we present any medication to which a
foresaid child is allergic or currently taking is listed above and that minor child is responsible
for consuming the prescribed dosage, and the prescribed medication will not be administered
by Polk County Aces or it’s staff.
I hereby certify that I have read and understand the foregoing.
Parent/Guardian Signature ______________________________ Date_____________