Date Registered: __________

2008-2009 Payment: _______________

DAKOTA SPIRIT Ck_________ Cash_______
TUITION PAYMENT AGREEMENT
$40 Registration Fee Due with Registration Forms

Student Name: Team: Date of Birth:

Party Responsible for Tuition Payment: Age as of 5/31/08:
Parent/Guardian Student lives with:
Address: Street City, St Zip
Mom Phone #: Home: Work: Cell:
Dad Phone #: Home: Work: Cell:
Mom Email address (statements sent):
Dad Email address (statements sent):
Payment Option-CHOOSE ONE: Monthly automatic withdrawal Monthly check Full Payment

Tuition includes practices, performances, Dakota Spirit Showdown, Valentine’s Day Classic, & SpiritFest. Returned checks
or insufficient funds are subject to a $30 fee. A $10 fee will be charged to student’s account for all late payments. Discount
figured in the one payment option. Travel fees & uniforms are not included in the tuition.

DAKOTA SPIRIT AUTHORIZATION FOR AUTOMATIC WITHDRAWAL

Person Authorizing Automatic Payments: Phone:

Address: Street City, St Zip
Financial Institution: Branch:
Account Number: Routing Number:
Monthly Draft Amount: CHECK ONE: Checking or Savings
I hereby authorize Dakota Spirit, LLC to initiate electronic entries to my checking /savings account for monthly tuition
payment for (student). I understand that I am responsible for notifying the Dakota Spirit office in the event that I
change my checking account to a different bank or account. I understand that I may revoke my authorization with Dakota
Spirit, LLC by written notification made within a minimum of 15 days prior to the 1st of the month. Drafts will be made the
fifth of each month beginning in June for All Star teams and August for Recreation Teams and continue each month until the
completion of the season in March or until my tuition has been paid in full. Travel payments must be paid separately.
PLEASE ATTACH VOIDED CHECK

I agree to the payment terms in this tuition agreement. I understand that the $40 registration fee and all required forms are
due at the time of registration in order for membership to be accepted. I understand that payments are due by the 5th of the
month and automatic withdrawals will be taken out at that time. I understand that my child’s participation is a commitment
for the entire season and all payments are nonrefundable. If I choose to leave the program I understand that I am obligated to
make notification in writing by the 15th of the month or I will be billed for the upcoming month. I understand that I will be
dropped from the program after 2 months if tuition is not paid.

Signature Print Name Date

Dakota Spirit - ONE TEAM, ONE SPIRIT

©Dakota Spirit, LLC 05/07
 DAKOTA SPIRIT, LLC
2008-09 Medical Information
Cheerleader’s Name: Team: DOB: Age as of 5/31/08:
No of years in Dakota Spirit: Grade for 08-09: School:
Medical Insurance: Policy #: Policy Holder:
Family Doctor’s Name: Doctor’s Phone Number:
Allergies: Medications:
Medications Dakota Spirit staff has permission to give my child:
Purpose of Medications:
Any previous illness or injuries, current or past medical history the staff should be aware of?
Mother: Father:
Address: Street City, St Zip Address: Street City, St Zip
Home Phone: Home Phone (if different):
Cell Phone: Work Phone: Cell Phone: Work Phone:
Place of Employment: Place of Employment:
Email Address: Email Address
Child’s Cell Phone (if applicable) Child’s Email (if applicable)

1. I, , legal guardian/ parent fully understand that I am responsible for payment of expenses incurred relating to my child’s
medical treatment as a participant in the activities of Dakota Spirit, LLC.
2. I certify that Minor is physically capable of participating in Dakota Spirit, LLC and has no previous injuries that will affect
participation.
3. I hereby have been forewarned that participation in Dakota Spirit, LLC, known as Dakota Spirit, has the following non-
exhaustive list of particular risks and injuries including but not limited to: sprains, strains, abrasions, dislocations, fractures,
concussion, contusions, blisters, head and neck injuries, illness, and possible death.
4. Having been forewarned, I assume all risk and full responsibility in connection with Dakota Spirit and hereby release all
instructors, staff, volunteers, practice and performance facilities, and others involved with Dakota Spirit from any injury that may
befall my child.
5. I agree to hold harmless Dakota Spirit for any injury incurred as a result of my child’s participation.
6. I am fully aware of the inherent risks in cheerleading and am willing to accept these risks to participants of Dakota Spirit.
7. I understand that Dakota Spirit strives to provide the maximum in safety precaution & student training.
8. I give permission for any medical treatment necessary in the event of illness or injury at practice, events, travel, competitions, or
any event we participate in with Dakota Spirit..
9. I have provided accurate information to the best of my knowledge regarding my child’s health and have alerted the staff of Dakota
Spirit with any medical concerns.
10. I have read, agree to, and fully understand the information and risks and agree to all payments required by my daughter as a
participant of Dakota Spirit..
11. I grant my child permission to be photographed, videotaped, or interviewed for the website, publications or press.
13. I give permission for my child to participate in team travel and have been made fully aware that I am responsible for supervision
of my child during trips.

PARENT SIGNATURE:________________________ STUDENT SIGNATURE:______________________ Date: __________

EMERGENCY CONTACT:
Name: Relationship: Phone Number:

Dakota Spirit - ONE TEAM, ONE SPIRIT

©Dakota Spirit, LLC 05/07
 Dakota Spirit, LLC

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

In consideration of participating in the Dakota Spirit, LLC program, I represent that I understand the nature of this Activ-
ity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I acknowledge
that if I believe event conditions are unsafe, I will immediately discontinue participation in the activity. I fully understand
that this Activity involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be
caused by my own actions, or inactions, those of others participating in the event, the conditions in which the event takes
place, or the negligence of the “releasees” named below; and that there may be other risks either not known to me or not
readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, cost, and
damages I incur as a result of my participation in the Activity.

I hereby release, discharge, and covenant not to sue Dakota Spirit, LLC, its respective administrators, directors, agents,
officers, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of
premises on which the Activity takes place, (each considered one of the “RELEASEES” herein) from all liability, claims,
demands, losses, or damages, on my account caused or alleged to be caused in whole or in part by the negligence of the
“releasees” or otherwise, including negligent rescue operations and future agree that if, despite this release, waiver of li-
ability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify,
save, and hold harmless each of the Releasees from any loss, liability, damage, or cost, which any may incur as the result
of such claim.

I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREE-
MENT, understand that I have given up substantial rights by signing it and have signed it freely and without any induce-
ment or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest ex-
tent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall
continue in full force and effect.

________________________________ Date: __________________________

Printed name of participant
PARENTAL CONSENT
AND I, the minor’s parent and/or legal guardian, understand the nature of the above referenced activities and the Minor’s
experience and capabilities and believe the minor to be qualified to participate in such activity. I hereby Release, dis-
charge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees
from all liability, claims, demands, losses or damages on the minor’s account caused or alleged to have been caused in
whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations, and further agree
that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the above Re-
leasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releases from any litigation expenses, attor-
ney fees, loss liability, damage, or cost any Releasee may incur as the result of any such claim.

Furthermore, I agree to the above RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEM-
NITY AGREEMENT on my own behalf for any adult participation in any Dakota Spirit activities.

_______________________________________ Date: ______________________

Printed name of Parent/or Legal Guardian

________________________________________________
Signature of Parent/or Legal Guardian

Dakota Spirit - ONE TEAM, ONE SPIRIT

©Dakota Spirit, LLC 05/07