Name:

Address:

City:

State:   Zip Code:

Daytime Telephone:  

Evening Telephone:  

Email:

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Have you ever auditioned for a professional, semi-professional,
minor league dance team? Yes No

If yes, please describe:



Please list any dance or cheerleading experience
(ex: hip hop, ballet, tumbling, etc):



Do you plan on auditioning for a team in 2010? Yes No

If so, please indicate which teams:

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WAIVER AND RELEASE

The Undersigned requests that she be allowed to demonstrate her skills and ability as a contestant during the auditions for a professional dance team. In consideration of being afforded such opportunity, the undersigned hereby assumes any and all risk of injury involved in such demonstrations and agrees to release and discharge Professional Cheerleaders Alumni, Inc., Bailey’s Powerhouse Gym, any parent, subsidiary, affiliate, successor, predecessor, or otherwise related companies, and the past, present, and future employees, agents, officers, attorneys, directors, shareholders and employee benefit programs of any of them, and their agents and insurers, from all claims of any nature whatsoever, for any injuries that may be sustained by the undersigned during such demonstration and auditions.

In recognition of the media coverage of the Professional Cheerleaders Alumni, Inc. and applicants therefore, the undersigned grants the Professional Cheerleaders Alumni, along with any parent, subsidiary, affiliate or licensee her permission and authority to use her name, voice, picture, and likeness in connection with any and all publications, broadcasts, promotions, photographs, promotional posters, commercial products, including but not limited to calendars, team pictures, t-shirts, videos, and digital images such as those on the PCA web sites.

The undersigned recognizes and understands that she may not be selected as a cheerleader to the team in which she auditions, and agrees to hold the Professional Cheerleaders Alumni, Inc., along with any parent, subsidiary or affiliate harmless if, for any reason whatsoever, she is not selected as a Cheerleader. The undersigned understands that taking the prep class does not guarantee she will be selected to be a Cheerleader to any professional or non-professional team.

By signing this Professional Cheerleader Alumni, Inc. Waiver and Release, the undersigned warrants that she is at least (18) years of age. If under the age of 18, a parent or legal guardian must sign. Photo ID must be shown at check-in.

By signing below, you agree to items stated above.

I agree to everything and I have read the above. Yes No

Parent or Legal Guardian (if under age 18):