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NAME_________________________________Date of Birth ___/___/____Age_____
ADDRESS AT HOME
__________________________________________________
SCHOOL ADDRESS
___________________________________________________
HOME PHONE
__________________
CELL # ______________________
SCHOOL PHONE
_________________
PARENTS'
NAMES
_______________________________________________________
Parents' Work Phone
_____________________ Parents' Cell Phone ______________
PARENTS ADDRESS IF
DIFFERENT THAN HOME ADDRESS
_____________________________________________________________________
YOUR
EMPLOYER____________________________________________________
SCHOOL ACTIVITIES
_________________________________________________
MAJOR
__________________________ ADVISOR NAME ___________________
HIGH SCHOOL
ATTENDED_____________________________H.S. GPA ______
May need assistance with
following for classes, tests, etc.,
____________________________________________________________________
UNIVERSITY OR COLLEGE
ATTENDED PRIOR TO HCC:
____________________________________________________________________
S.S.N. __________________
SHOE SIZE____ SHIRT SIZE ______
PANT SIZE ______HEIGHT_______
H.S.# of Years
Cheered______ All Star Squad? Yes No
College # of years
cheered______
TUMBLING SKILLS
MASTERED:
Standing back hand
spring___; Standing back tuck _____
2
highest tumbling passes on
spring floor ______________________________________
________________________________________________________________________
________________________________________________________________________
2
highest tumbling passes on
mat floor ______________________________________
________________________________________________________________________
________________________________________________________________________
MEDICAL CONDITIONS,
ALLERGIES, RECENT INJURIES, TREATMENT NEEDS:
_______________________________________________________________
(if confidential, do not
disclose here - instead circle "see health forms for details"
and visit with Lisa Ward)
OTHER
How would others describe
you?_______________________________________
________________________________________________________________
What would you like to
see most from a team you join?______________________
________________________________________________________________
What specific strengths
can you contribute to our team? _____________________
________________________________________________________________
What time commitment are
you willing to give to the cheer team while at HCC?
________________________________________________________________
What would you consider
to be your most outstanding personal accomplishment?
_______________________________________________________________
List any community
relations activities you have been involved with in the last 3 years.
(Please give specific dates).
_____________________________________________________________
_____________________________________________________________
Could you attend
summer camp and
be available for weekly practices during the summer?____________
_________________________________________________________________________
I
_________________________________, have read all rules and information
pertaining to tryouts and being a member of the Cheer Team at
Hutchinson Community College, I do hereby claim that all information I
have submitted is accurate.
____________________________________ __________________
Candidates Signature Date
RELEASE AND
INDEMNIFICATION
I, the undersigned,
for and in consideration of being allowed to try-out, participate,
perform and practice the sport of cheerleading/dance, do hereby
release Hutchinson Community College and it's employees and student
athletes. While acting within their scope of employment, from any
liability for injuries or illnesses, pre-existing or aggravated, or
that may be incurred by me while engaged in this program as a
non-grant-in-aid student-athlete. Recognizing that conditioning,
practice and participation in intercollegiate athletics involves
bodily contact, physical stress, and the possibility of injury, or
even death; I voluntarily assume all risks incident to my
participation. I also understand that no athletic accidental
insurance will be provided for me and Hutchinson Community College
will not pay for any injury or illness sustained by me which resulted
from my participation in said activity.
I, the undersigned, have
medical insurance coverage either under my parent's plan (attach
certificate of insurance) or personal plan (attach certificate of
insurance).
I,
___________________________________ , have read the above and
foregoing release and indemnification and I understand the statements
contained therein: I assume all risks involved and I have v\waived
all rights, now and in the future, to assert any claim whatsoever
against Hutchinson Community College and its agents for injuries I
might sustain, and furthermore, the medical insurance verification
contained therein is true and correct to the best of my knowledge and
belief.
_____________________________________ _________________
Signature of Student-Athlete
Date
_____________________________________
Signature of Parent or Guardian (if under age 18 or covered by
parent insurance)
_____________________________________
Witness
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