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TEAMS
BASEBALL
SOCCER
DRAGON DOLLS
LIVE
RADIO
NJCAA
BLUE DRAGON ATHLETICS HUTCHINSON COMMUNITY COLLEGE ATHLETIC DEPARTMENT 1300 N. PLUM HUTCHINSON, KANSAS 67501 (620) 665-3530 FAX # (620) 665-3394
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Cheer Team Member QuestionaireNAME_________________________________Date of Birth ___/___/____Age___ ADDRESS AT HOME _______________________________________________________________ SCHOOL ADDRESS ________________________________________________________________ HOME PHONE _______________CELL # ______________SCHOOL PHONE _________________ PARENTS NAMES _________________________________PARENTS PHONE_________________ Parents Work Phone _____________________ Parent's Cell Phone _______________(to be used in emergency) 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 standing back handsprings ____; 3 + back handsprings _____; back tuck _____ Round off + back handspring _____; 2 back handsprings _____; Most difficult tumbling pass; _____ JUMP SKILLS___________________________back tuck_______; Toe Touch _____; Pike _____; invert toe touch _____; Jay out _____; Full _____ Round the world_____; Front hurdler _____; X out _____; Full _____ 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 Could you attend 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, do hereby claim that all information I have submitted is accurate. ____________________________________
__________________ 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. _____________________________________
_________________ _____________________________________ _____________________________________
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