2017 EAST/WEST ALL-STAR FOOTBALL GAME August 5th, 2017 Baker City, Oregon

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1 2017 EAST/WEST ALL-STAR FOOTBALL GAME August 5th, 2017 Baker City, Oregon Once a year, Oregon's best and brightest senior football players and cheerleaders from the 1A to 4A high schools meet in Baker City to participate in an all-star football game that is much more than a game. These healthy players and cheerleaders are playing for the children who are patients of Shriners Hospital for Children. The players and cheerleaders learn why they play/cheer in this important game, when they visit Portland Shriners Hospital for Children and meet the children for whom they are playing. This meeting with the children forms bonds between the players and the patients. The players learn how important their contribution is to these children through interaction and play, leaving the players with a new understanding of their mission. The players and cheerleaders participate with a common goal and, although they play on two different teams, they are united in their purpose and are only opponents on the field. Shriners Hospitals for Children is the only pediatric health care system in The United States that provides care and services regardless of the patient s ability to pay. Shriners Hospital for Children is one of the largest pediatric sub-specialty health care systems in the world. The three Shriners Hospitals for Children specializing in burn care are the only hospitals initially established for the exclusive treatment of pediatric burns and related conditions. A fourth hospital in our health care system offering treatment for burns also provides care of orthopedic conditions, spinal cord injuries and cleft lip and palate. Since the first Shriners Hospital opened in Shreveport, LA., in 1922, the Shriners health care system has cared for nearly one million children. In 2011, Shriners Hospitals for Children cared for 121,713 children including: -285,154 outpatient, outreach and telemedicine clinic visits -10,109 prosthetic patient visits (inpatient and outpatient) -51,288 orthotics patient visits (inpatient and outpatient) Cheerleaders are selected by an application process. The cheerleaders for this event are sponsored by the OCCA (Oregon Cheerleading Coaches Association). Coaches must be a member of OCCA to nominate cheerleaders for the game. Applications may be found on the OCCA website under Special Events,

2 Shrine Game. Applications are posted by January of each year and are due March 31 st, The football players who are selected will be 2016 graduates; we encourage your current senior cheerleaders to apply. The Shrine Cheerleading team is open to all 2016 graduates. If we do not have enough current graduates to fill the team, the team will be open to Class of 2017 cheerleaders who have applied. If you are selected to participate in this extraordinary event you will build friendships, make unforgettable memories, participate in all game activities, half time performance, game day parade, and Shriners Hospital visit. You will be provided with a game day t-shirt, practice t-shirt, poms, bow, and daily meals. Hotel expenses are paid by the Shriners and OCCA. Cheerleaders will need to provide their own transportation to choreography, hospital visit and Baker City. Cheerleaders who are named to the team will also be REQUIRED to obtain a $250 sponsorship from local businesses. Sponsors will be featured in the game day program. Once you have been selected, more information will be sent regarding this process. To participate in the game, a sponsorship is REQUIRED by all cheerleaders. We are looking for both female and male athletes who excel at the sport and who are leaders on their team and school. Tumbling is not required however; we are looking for the most talented athletes. It is an honor to be named to the Shrine Team. Please only recommend the most deserving athletes and all around athletes. The number of applicants continues to grow every year. Please understand that we may not be able to select all of your applicants. Priority will be given to 2017 graduates. We definitely try to include as many schools as possible and try to name at least one athlete from each school that has applied. Required s Cheerleaders must be available for the dates listed below, no exceptions will be allowed. If you are not available during the dates below, please do not apply for the team. July 27 th -28th - Hospital Visit and Choreography August 3 rd -5th - Game in Baker City For more information or if you have questions, please visit our Shrine Cheerleading Facebook page and the official game website at Amber Rosa OCCA East/West All-Star Football Game Coordinator Amber_rosa@hotmail.com

3 2017 EAST/WEST ALL-STAR FOOTBALL GAME CHEERLEADER APPLICATION Name: Age: Mailing Address: City: Zip Code: Phone Number: ( ) (please be sure your address is correct, this will be the primary form of communication) High School: Please circle one: CLASS OF 2017 GRADUATE CLASS OF 2018 Please place an X if you: A-4A All State Team Member. Participant in the 2016 All State Individual Competition. Participant in the 2016 All State Stunt Competition T-shirt Size: Cheerleading: (Please list your cheerleading experience)

4 Tumbling: (please circle the skills you are comfortable performing on a grass field) Standing BHS Standing Tuck Running Tumbling Pass (Round off BHS/Series) Other: Stunting: (circle the skill set you are MOST comfortable performing) Beginning (preps, thigh stands, basic cradles) Intermediate (one foot stunts at prep level, extensions, toe touch baskets, basic pyramid sequences) Advanced (extended one foot stunts with different body positions, inversions, full ups, advanced pyramid sequences, full down cradles) Please circle ALL stunting positions you are comfortable performing: FLYER BASE BACK BASE FRONT BASE **You may NOT be performing the stunting position you are used to performing. We need team members that are willing to learn and perform the position asked of them**

5 Cheerleading Achievements: Academic Achievements: ***HIGH SCHOOL JUNIORS/COACHES*** MORATORIUM WEEK Moratoium Week is July th this year. If you will still be in High School (Junior applicants) during the Shrine events, you and your school will need to apply through the OSAA for an exception to be able to participate in the Hospital visit and choreography portions. It is the responsibility of the athlete, coach and AD of each school to request and seek approval for this exception. Failure to do so may result in fines or penalties for your school. The OCCA and Shriner s Organization s will not be liable or responsible for any schools who do not comply. You may contact Kelly Foster with the OSAA for questions and exception requests. Kelly Foster x233 kellyf@osaa.org High School Coach Signature (REQUIRED): Address: Phone Number: Cellphone Number:

6 Application Instructions Please send completed application and portraits to: Mail: Terry Griffith Ladera Road SE Bend, Ore Applications must be submitted or postmarked by March 31 st, 2017 in order to be considered. All forms MUST be completed in order to be considered for the 2017 Shrine Team. Please use the checklist below to be sure you have completed all forms due. Applications must be signed by your current high school coach. Application Cheerleader Ethic Form High Resolution Digital Picture (5x7 Print / Digital 4mg) Cheerleaders/Parent Consent Form Cheerleader Information Sheet Cheerleader Insurance Form Photo/Information Release Form Physician s Form $250 Sponsorships (Not due until May ) **Physician s Form MUST be completed to cheer at the game. ALL cheerleaders must be physically able to perform cheers, dance motions, jumps, and stunting. This form can NOT be replaced with a current sports physical per Shriners.** All of the above forms must be completed in order to be considered for the team! Questions? Please contact: Amber Rosa Heidi Lagao (call or text) (call or text) Amber_rosa@hotmail.com Kolshots@gmail.com

7 CHEERLEADERS and PARENT/GUARDIAN CONSENT FORM Please Print Clearly when completing form TO SHRINER S HOSPITAL OREGON EAST-WEST ALL-STAR COMMITTEE We hereby give our consent for the participation of our son/daughter. Cheerleaders Name As a cheerleader in the Annual Shriner s Hospital Oregon East-West Football Game to be played at the Baker High School Stadium, Baker City, Oregon on August 5 th, It is understood that the East-West Shrine Football Game Organization shall provide supplementary or secondary insurance for medical care and expenses for your daughter/son in the event of accident/or injury during her/his participation becoming effective when your personal coverage ceases. In the event your daughter/son is injured, do we have your consent to take him/her to a local doctor or hospital for an examination and/or treatment? YES or NO Family Doctor: Family Dentist: Please Print Legibly: Cheerleader s Full Legal Name: Cheerleader s Known by: Address: City: Zip: Mailing Address (if different): Address: Phone Number: Cellphone Number:

8 Birthday: Mo Day Year Cheerleader s Signature Parent/Guardian Name (please print): Parent/Guardian Signature: Address: City: Zip: Mailing Address (if different): Address: Phone Number: Cellphone Number: Parent/Guardian Signature Parent/Guardian Signature When Submitting a Photo for Programs, Websites and Misc. Media: Please submit your photo in High Resolution Digital Picture (5x7 Print / Digital 4mg). If we don t receive a usable image, we will try to contact you. If we don t hear back you in a timely matter, you give us permission to search social media for one. Cheerleader Signature Parent/Guardian Signature

9 East West All-Star Game Cheerleader Information Sheet (All Must be Filled Out For Program) Name: School: Mascot: Cheerleading Highlights / Honors: Other Athletic or Academic Highlights / Honors: Community / Volunteer Activities: College / Vocational Future Plans: Phone:

10 East- West Shrine All-Star Cheerleader / Coach Insurance Form The accident insurance policy provided by the Shrine East-West Game Committee is supplementary or secondary to your personal family insurance policy, becoming effective when your personal insurance coverages ceases. This policy covers accidents sustained by duly registered participants in the game or related activities. It does not cover any illnesses, mental health, diseases or naturally caused ailments unrelated to an accidental injury. To properly register the cheerleader for insurance coverage, the following information is required. To expedite and avoid confusion, please complete all the information requested. Insurance Company: Policy Number: Name of Policy Holder: Cheerleader s Full Name: Cheerleader s of Birth: Parent/Guardian Name (please print): Address: City: Zip: Mailing Address (if different): Address: Phone Number: Cellphone Number: Cheerleader Signature Parent/Guardian Signature

11 Cheerleader Ethic Form The purpose of a code of conduct for our Cheerleaders establish a consistent expectation for athletes behavior. By signing this code of conduct, I agree to the following statements: I will respect and show courtesy to my teammates and coaches at all times. I will demonstrate good sportsmanship at all practices and EW games / events. I will set a good example of behavior to my teammates and others around me. I will be respectful of my teammates feelings and personal space. Athletes who exhibit sexist, racist, homophobic, or otherwise inappropriate behavior will be faced with consequences. I will attend all EW cheer team meetings, training sessions and events / game. I will show respect for all facilities and other property (including hotel rooms) used during practices, EW events & activities, and overnight stays. I will refrain from foul language, violence, behavior deemed dishonest, offensive, or illegal. If I disagree with an official s call, I will talk with my coach and not approach the official directly. I will obey all OSSA rules and codes of conduct. I understand that if I violate this code of conduct, I will be subject to disciplinary action determined by my coaches and The EW Shiner All-Star Committees. I Refrain from the use of alcohol, tobacco, illegal and non-prescriptive drugs, anabolic steroids or any substance to increase physical development or performance that is not approved by the United States Food and Drug Administration, Surgeon General of the United States or American Medical Association. Exhibit fair play, sportsmanship and proper conduct on and off the playing field. Cheerleader Signature Parent/Guardian Signature

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13 Shrine East-West All-Star Football Game All-Star Cheerleader Physician Form Signature of a license physician is required to participate in all East-West All-Star Football Game cheerleading activities. There is no medical or physical reason indicated to prevent (Please print name of cheerleader) from participating in cheerleading activities for the East-West All-Star Football Game (including practices) from July 27th-August 5th, 2017 in Sweet Home and Baker City, Oregon. The main cheerleading activities will be on August 5 h, 2016 at the East-West All-Star Football Game. Licensed Physician s Signature Address Phone Number *A current sports physical does NOT take the place of this form*

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