Pom & Dance Registration Form

Pom & Dance Registration
Pom & Dance Class (Ages 3–6)
Introduce your little one to the fun and fundamentals of cheer through our Pom & Dance class! Designed for ages 3–6, this class focuses on basic dance, pom motions, rhythm, coordination, and age-appropriate cheer skills in a positive, high-energy environment. Athletes will learn teamwork, listening skills, confidence, and sportsmanship—all while having fun and making new friends.

🗓 Thursdays: 5:00–6:00 PM

📅 Session Dates: February 5th, 2026 – April 30th, 2026
💲 Tuition: $80 per month
🏷 One-time gym registration fee: $50

Perfect as an introduction to cheer and dance, this class helps build a strong foundation for future athletes—one beat at a time ✨

Registration will include poms & bow!
Athlete Information
Athlete's Name*

First NameLast Name
Birth Date*

MonthDayYear
Athlete Age*
MaleFemale
Athlete Birth Certificate

Revive Cheer Athletics requires a copy of the athlete's birth certificate to be kept on file.
File Upload

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Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your athlete have previous cheer or dance experience? If yes, please list how many years.*
Parent/Guardian Information
Name*

First NameLast Name
Home Number*
Format: (000) 000-0000.
Cell Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is the athlete prescribed an inhaler? If yes, please explain any instructions.*
Athlete sports physical

Revive Cheer Athletics requires a copy of the athlete's sports physical to be kept on file.
File Upload

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Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Revive Cheer Athletics during the season. In exchange for the acceptance of said child’s candidacy by Revive Cheer Athletics, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Revive Cheer Athletics. and all its respective officers, agents, and representatives from any and all liability for injuries.

In case of injury to said child, I hereby waive all claims against Revive Cheer Athletics. Including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities.
YesNo
Antibiotic ointmentAlcohol wipesBenadryl Cream
Media Release

Photos and videos will be posted throughout the season on all social media platforms and other public platforms of athletes during practice, competitions, Revive events, etc. without consent from athletes/parents.
By checking this box, I acknowledge and give Revive Cheer Athletics permission to use any photo/media content of my athlete.
Financial Agreement

I agree and understand I am financially responsible for the registration fee, before starting the class. I understand that if payments are late, a 10% late fee will be added, and my athlete may be suspended until paid in full. I understand there is no refund if you are unable to attend class every week. I understand that any past due or open invoices will remain my financial responsibility if my athlete becomes injured, dismissed from the program, or chooses to leave the program. Revive Cheer Athletics has a no refund policy. Revive Cheer Athletics has the legal right to turn any delinquent account balances over to a collection agency.
By checking this box, I acknowledge and agree.
REVIVE CHEER ATHLETICS COMPLETE POLICY AGREEMENT

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. BY SIGNING BELOW, I UNDERSTAND AND AGREE WITH ALL OF THE INFORMATION AND TERMS OF REVIVE CHEER ATHLETICS POLICIES.

Class registration*

Pom & Dance Registration

$50.00

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Total

$0.00

Credit Card

Signature*
Date*

MonthDayYear
Date
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Pom & Dance Registration

Athlete Information

Athlete Birth Certificate

Athlete sports physical

Media Release

Financial Agreement

Credit Card