2014 JINGLE BELL BATTLE
2015 BLIZZARD BATTLE
2015 SHAMROCK SHOWDOWN
CHEER AND DANCE COMPETITIONS
MEDICAL, LIABILITY AND MEDIA RELEASE FORM
In consideration of the acceptance of entry to any / all of the Jingle Bell Battle, Blizzard Battle or Shamrock
Showdown Cheer and Dance Competition(s) (hereafter referred to as “the Event”), and intending to be legally
bound for myself, the organization listed below, all minor children listed on our roster (hereafter referred to as
“Athletes”), the responsible parent(s) and/or guardian(s) for all ATHLETES and our/their heirs and assigns,
executors and administrators, hereby give consent for all ATHLETES to participate in said event and waive and
release any and all rights for liability and damages we may have against any sponsor, co-sponsor, individual,
volunteer, officer, director, employee, contractor, licensee, and/or official of West Shore Youth Athletic Association
(WSYAA), West Shore Shock Cheerleading, The Jingle Bell Battle, The Commonwealth of Pennsylvania (PA), PA
Department of Agriculture, PA Farm Show Complex and Expo Center, West Shore School District, and/or Red
Land High School (hereafter collectively referred to as “Event Organizer(s)”) for any and all injuries, illness or
death that may result from or arise by participation in THE EVENT. I acknowledge that it is my responsibility to
understand and ensure the responsible parent(s) and/or guardian(s) for all ATHLETES also understand the
precautions that should be taken and accept and assume the liability for any and all risks, without limitation, from
participating in THE EVENT including, but not limited to physical injury, including catastrophic injury, emotional
injury, sickness, death, property damage, falls, collisions with people or objects, the unavailability of emergency
medical care, and/or the negligence and/or deliberate act of another person. I further state that all ATHLETES have
sufficiently trained for and are physically fit and in proper condition to participate in THE EVENT and authorize
WSYAA and Event Organizers to transport or authorize transport of the ATHLETE to a medical facility and/or
hospital and to authorize emergency medical treatment to the participant while at THE EVENT.
I attest that I have truthfully and accurately completed Roster(s) for all ATHLETES on all teams and understand
that teams or ATHLETES with missing or inaccurate information will not be permitted to compete. Intentionally
false or misleading information will result in immediate disqualification and removal from competition without
refund, remuneration or further consideration and I have read and understand all rules and guidelines provided to me
by WSYAA and Event Organizers for THE EVENT. I understand and agree WSYAA and Event Organizers reserve
the right to immediately remove, without warning, any person who engages in profanity or un-sportsman-like
conduct directed at any competitor, coach, official, spectator or Event Organizer. I also understand and agree
WSYAA and Event Organizers reserve the right to immediately remove, without warning, anyone who consumes or
uses alcohol or illegal drugs at THE EVENT and its premises or appears to be under the influence of same. All
decisions of judges, WSYAA and Event Organizers on any of these matters are final.
I also grant WSYAA unrestricted right to copyright and/or use the name, image, and/or picture of all ATHLETES in
any document, newspaper, broadcast, telecast, or any other account of THE EVENT without limitation and without
compensation to myself, the organization, the ATHLETE or their parent(s) and/or guardian(s).
I attest that I am who I claim to be, that I am the representative of the organization listed below, that I am authorized
to sign this medical, liability and media release on behalf of the organization and also that the responsible parent(s)
and/or guardian(s) for all ATHLETES also understand and are in agreement with all above terms and conditions. By
execution the undersigned has hereby agreed to be and shall be legally bound hereby and acknowledges this
agreement is supported by adequate consideration.
I, ______________________________________________, having the position __________________________________ with
Printed Name of Coach
Official Position with Organization
_____________________________________________________________________ agree to the above terms and conditions
Name of Organization
______________________________________________________________
Signature of Organization Official
_______________________________
Date of Signature