Tryout Packet Phone: (936)

Transcription

1 Tryout Packet Phone: (936) Website: Address: SFA Spirit Teams Attn: T.J. Maple P.O. Box SFA Station Nacogdoches, Texas 75962

2 Cheer Specific Information: Dates and Times (Dates are mandatory): Saturday, May 5, :00-4:00 PM: Registration & Check In 4:00-5:00 PM: Fight Song Taught & Cuts Made 5:00-6:00 PM: Maybes stay for further Evaluations 7:00-8:30 PM: Standing & Running Tumbling 8:30-10:00 PM: Stunting 10:00 PM: Closing Remarks & Sunday Expectations Sunday, May 6, :00-9:00 AM: Stretch/Work on Own 9:00 AM: Tryouts (Both Teams) Location: All aspects of SFA tryouts will be held in the HPE Complex on the SFA campus. Attire (for entire weekend): Females Plain black or purple sports bra, black spandex shorts, cheer shoes, and hair fixed half up and half down and fashioned out of your face with a purple, black or white ribbon/bow of your choice. For Saturday evening, hair will need to be curled. Males Plain black or purple T-shirt, black gym shorts, cheer/athletic shoes, no hats and clean-shaven. All potential cheerleaders are expected to portray a collegiate image when trying out for SFA. Body piercings and jewelry of any kind, extreme hairstyles and/or colors are not acceptable at tryouts or during the year as an SFA cheerleader. All cheer candidates must remove all piercings and other jewelry prior to arrival at tryouts. General Requirements for Tryouts: o Large Coed: Standing back tuck (jump to tuck combinations preferred) Toss to hands liberty Standing back handspring tuck (jump combination preferred) Complete the stunt and/or tumbling position requirements Fight song, taught at tryouts (w/tuck) o FEMALES: All females are required to try out with a minimum of a round-off back handspring layout. o Stunting Position - Full-up stunt Optional stunt, which can be a combination or sequence Two-handed rewind of two stunts. One of the two stunts must double down with two hands from an advanced body position that shows flexibility. o Tumbling Position - Round-off back handspring full An additional tumbling pass with two or more elite skills that ends in a full Standing tumbling pass that ends in a full o Small Coed /All-Girl: Toe touch back tuck (multiple jump combinations preferred) Full-up stunt that must end in an advanced body Toe touch handspring tuck (multiple combinations preferred) position that shows flexibility, and doubles down. Round-off back handspring layout Optional stunt, which can be a combination or sequence of two stunts Fight song, taught at tryouts (w/tuck) Toss liberty **Please note: Once a candidate makes the program, the coaching staff will decide where that athlete is best utilized for the season.**

3 Dance Specific Information: Dates and Times (These dates are mandatory): Location: Friday, May 4, :00 p.m. Registration and Check-In/work on technique choreography All aspects of SFA tryouts will be held 6 8:00 p.m. Technique Cuts in the HPE Complex on the SFA 8 10:00 p.m. Fight Song Choreography Taught (invitation only) campus. Saturday, May 5, 2018 (invitation only) 8 a.m. Fight Song/Game Day and Solo Routines (NO LONGER THAN 1:30 minutes) Attire (for entire weekend other than Solo): Females Any color bra top ( NO orange please), black hot shorts, tan jazz shoes, tennis shoes, and hair fixed half up, half down, and fashioned out of your face. Males Any color plain T-shirt/tank ( NO orange please), black gym shorts, tan jazz shoes, tennis shoes, no hats and clean shaven. All potential dancers are expected to portray a collegiate image when trying out for SFA. (Body piercings and jewelry of any kind, extreme hairstyles and/or colors are not acceptable at tryouts or during the year as an SFA dancer). All dance candidates must remove all piercings and cover tattoos prior to arrival at tryouts. General Requirements for Tryouts: o Experience in Pom, Jazz and Hip Hop styles; o Strength and power in all movement; o Most importantly SFA is looking for performers; and o Ability to captivate a crowd. Required Skills: o Leap in Second to Right/Left o Switch Leap to Right/Left o Calypso Leap to Right/Left o Switch to second to Right/Left o Turning Disc o Quad Pirouette o Fouettés ala Second (2 counts of 8) o Aerial Cartwheel (Right or Left) o Toe Touch Note from the coach: We will be looking for well-rounded dancers with outstanding skills and technique. Do not assume that a weakness in any one area which will automatically disqualify you as a team member. We will be looking for the dancer that is eager to learn and displays a positive attitude at all times. Egos should be left at the door. Any past accomplishments in dance or otherwise carry very little weight in the selection process. Candidates will tryout in mass and small group will be assigned by the coaching staff Saturday. There are no scores; all decisions are based upon work seen by the coaches and judges. The coach will make all final decisions on team member selection. Any candidate who has questions after the team has been selected may call Coach T.J. Maple on the Monday following tryouts. Outbursts or questions from parents will not be accepted. Keep working on your skills! We look forward to meeting and working with you. Axe `Em, Jacks! Miscellaneous Preferred: o Head Stand o Head Spring o Kip Up o Stahl o K-Stand o Leg Extensions Right/Left o Leg Hold Turns

4 Mascot Specific Information: Attire: All candidates must provide a mascot outfit they feel represent the traditional Lumberjack or Ladyjack, while also displaying personal ideas and character. General Requirements for Tryouts: o Create a video that shows that you have what it takes to be the next Lumberjack or Ladyjack. o Submit your video to: spirit@sfasu.edu *If you do not have ALL of this information, you will NOT be allowed to participate in the tryout.* *In the event a mascot is not needed, tryouts will not take place.* All Spirit Teams Candidates: Eligibility to Tryout (All paperwork is due at arrival to Tryouts): Spirit Teams Application and Application Agreement $25 Application Fee (non-refundable) Close-up photograph Two letters of recommendation High school or transfer school transcripts Waiver of liability, signed by a parent if you are under 18 years of age. SFA Letter of Acceptance o Must be accepted to SFA as a fulltime student or must have applied and submitted your transcripts and test scores for admissions OR YOU WILL NOT BE ELIGIBLE TO TRYOUT! *RETURNING MEMBERS: You will be expected to perform at a higher standard than other candidates if you have been a part of the SFA Spirit Program for at least one year. In addition to the standard tryout requirements, you will be judged on attitude, work ethic, integrity and the character that you displayed during the previous year.*

5 SFA Spirit Teams Application Name: Age: Date of Birth: Home Address: City: State: Zip Code: Mobile Phone: High School: Have you ever competed ON THE MAT at a Varsity Spirit Collegiate Event? YES NO If so, how many years of eligibility do you have? Check ALL that apply to you for YOUR tryout: Male Female Large Coed Small Coed All Girl Dance Teams Coed Base Main Base Side Base Back Spot Flyer Tumbler Incoming Freshman Mascot Transfer Student Attach Photo Here

6 Spirit Teams Scholarship Application Agreement (please print clearly) Please have all paperwork completed when you arrive at tryouts. I,, submit this application for a position in the SFA Spirit Program. For the season, my academic classification will be. By submitting this application, I understand and agree to the following: I will be a full-time student, taking a minimum of 12 credit hours for undergraduate or 9 credit hours for graduate students at SFA for the entire fall and spring semesters. I must maintain a 2.25 GPA for scholarship and will hereby release my academic transcripts to the spirit coordinator. I understand that I must be in good standing with SFA or my high school and not on any type of academic or disciplinary probation. I must turn in the following paperwork to the spirit coordinator when I arrive at tryouts: o Spirit Teams Application o Spirit Teams Application Agreement o $25 Application Fee (non-refundable) o High school or transfer school transcripts or SFA unofficial transcript and class schedule o Two letters of recommendation (one from a coach and one from a teacher/counselor) o Waiver of liability, signed by parent if under 18 years of age o Copy of SFA Acceptance Letter Must be accepted to SFA as a full-time student or must have applied and submitted your transcripts and test scores for admissions OR YOU WILL NOT BE ELIGIBLE TO TRYOUT o Close-up photograph I understand that not having all of these requirements could disqualify me from trying out for a spirit team position. If selected, I understand that I am required to be covered by personal primary medical insurance (accidental insurance minimum) throughout my time as a SFA Spirit Team member. I have no health or physical defects, which would hinder my ability to perform as an SFA Spirit Teams member or that might cause performing as an SFA Spirit Teams member to be unsafe to my health or the health and well being of my teammates. The physical demands of being an SFA Spirit Teams member require that I maintain a high level of physical fitness and that I pass a complete physical examination administered by SFA medical staff. If selected and I accept a Spirit Team position, I understand I will be required to attend all scheduled practices, classes, performances, summer camp, sporting events, pep rallies, team meetings, parades, alumni functions, and other functions or duties designated by the spirit coordinator. I understand I am agreeing to a FULL YEAR commitment (fall AND spring semesters). *Should I choose to leave the program or am removed, I am aware that I will be responsible for repaying scholarship awarded. Being an SFA Spirit Teams member is a major personal commitment of my non-academic time and cannot be placed secondary to any other non-academic activity. I understand that, with the exception of academics, my commitment to the SFA Spirit Program takes FIRST priority over all other activities (sorority, fraternity, clubs, organizations, work, etc.). Furthermore, I understand that last-minute appearances/events may arise in which the spirit teams must be present. I am responsible for the care and upkeep of all components of the cheerleading uniform, and must keep all components of this uniform in acceptable condition. SFA will be responsible for all the financial obligations regarding these items, minus a rental/upkeep fee for which I will be responsible. The SFA Spirit Teams play an important role in representing the university and its athletic program. As such, I will always know that I am an official representative of SFA, its students, faculty and staff members, alumni, and Spirit Program. I will always conduct myself in a manner to uphold that character, tradition, integrity, and spirit of SFA. I understand and agree to be financially responsible for all items needed that will not be provided to me by SFA. I agree to follow all safety guidelines deemed necessary by the spirit coordinator, head coach and AACCA. I understand that I must maintain an account and check it DAILY. I understand that I must obtain a note from a family or school physician to be excused from any assigned function, unless approved in advance by the spirit coordinator. (If for any reason a cheerleader is unable to attend a function to which they are committed, he/she is responsible for finding another team member to replace him/her). I understand and accept that failure to meet any of the requirements listed above will result in my disqualification from consideration for an SFA Spirit Team position. I accept and understand that the decisions of the judges/coaches will be final. Signature Date

7 Stephen F. Austin State University Spirit Program Commitment Agreement Please initial each statement to indicate that you agree with each statement as well as understand that it is your responsibility to adhere to each guideline throughout your entire season as a member of the SFA Spirit Program. In accepting a role as a member of the SFA Spirit Program, I understand that this position requires that I meet a certain set of standards. These standards have been established to ensure the best possible experience for myself, other program members and SFA students at large, and to promote the feeling of camaraderie and support, which is essential to a successful organization. CONDUCT Spirit Team members have a responsibility to all members of the Spirit Program. This includes, but is not limited to, directors, professional staff, coaching staff, captains and each other. A commitment to the SFA Spirit Program takes FIRST priority, with the exception of academics, over all other activities, sorority, fraternity, clubs, organizations, etc. Participation in outside cheer or dance teams will only be allowed with the understanding that no SFA Spirit Program commitments be overlooked or compromised due to participation. Work schedules must also be around practice times and games. Spirit Team members understand that the decision to become a member of the SFA spirit program requires a full-year commitment. If a squad member chooses to leave the program at any time, it will result in not being able to participate the following year and reversal/pay back of any scholarship awarded unless there are extenuating circumstances. Spirit Team members must complete and turn in any remaining required paperwork no later than June 1, 2018 to remain eligible for the team, upcoming practices and/or camp. This includes current and effective insurance plans, copies of all required documents, and any financial obligations to the program. Insurance plans must remain active for the duration of the student-athlete s participation in the Spirit Program. SFA Spirit Team members play a constant and important role in representing the university and its athletic programs, as such, Spirit Team members will be official representatives of SFA, its students, faculty and staff members, alumni, and the spirit program. Members are expected to conduct themselves in a manner that upholds that character, tradition, integrity, and spirit. Furthermore, any unsportsmanlike conduct by any member of the SFA Spirit Program will not be tolerated. Squad members will be treated as adult student-athletes. It is the student-athlete s choice to participate at the collegiate level. Parent/guardian phone calls to coaches or intervention from parents/guardians with coaches will not be allowed. Squad members are expected to be responsible, and to be on time for practices, athletic events, meetings, etc. I understand that if I fail to show up to a scheduled practice, athletic events, or any other event and fail to notify the head coach BEFOREHAND, it will result in a write-up and meeting with the coaching staff, as well as any other consequences deemed necessary by the Spirit Programs Office. I will be sensitive to the uniqueness of each situation and the individual(s) involved, thereby promoting understanding and respect for various opinions, values and cultural backgrounds. I will not tolerate any incidents of prejudice or biases related to gender, race, ethnic origin, sexual orientation, religion or ability. I will not condone or participate in drug use as a member of the SFA Spirit Program. It is understood that Spirit Program members will be drug tested throughout the year.

8 SFA Spirit Program members will not drink alcoholic beverages before any event or activity including, but not limited to, practice, athletic events, etc. This pertains to all activities on or off campus. Spirit Team members must understand and adhere to the rules and regulations set forth by the coaching staff. Any infractions to these rules, and/or infractions to the SFA Cheer, Dance, and Mascot Handbook will result in a write-up issued by the coaching staff. POLICY Academic Spirit Team members will be full-time students, taking a minimum of 12 credit hours for undergraduate or 9 hours for graduate students at SFA for the entire fall and spring semesters. Failure to be enrolled in the required hours will result in termination from the squad and reversal of any scholarship. Spirit Team members must maintain a 2.25 cumulative GPA to continue to receive scholarship. Spirit Team members must maintain a 2.00 cumulative GPA to be eligible to compete at nationals. An SFA Spirit Team member may not enroll in a night class or a class during regular practice times unless that course is offered only at that time. Spirit Program members also are given the opportunity to register early each semester, and should take full advantage of this right. Spirit Program members should not wait until the last minute to register for classes when class schedules are closing or becoming full. It also is essential to be advised as early as possible to avoid any registration delays. I understand that the SFA Spirit Office will conduct random grade and attendance checks to ensure I am on target for satisfactory progress, and release that information to the coaching staff for these purposes. I understand that the SFA Spirit Office will maintain communication with SFA faculty to gather information on my academic progress. This includes contact by , phone, and one-on-one meetings. I understand that if I am not proving to be academically successful, the SFA Spirit Office will require me to participate in additional mandatory study hours, get extra help, or any other course of action deemed necessary to increase academic performance. This includes possible temporary suspension or probation from the team. I realize that by agreeing to this I am granting the SFA Spirit Office and the Registrar s Office access to my academic records, to make contact with my professors and any other provisions set forth under the Family Educational Right and Privacy Act (FERPA), which is deemed necessary by the Office of Student Affairs for eligibility purposes. Practices, Athletic Events and Meetings Practices, games and squad functions (ex. fundraisers, performances, pep rallies, etc.) are mandatory. There are no exceptions to this rule. If a squad member misses three functions in any given year without proper clearance from the head coach, it will result in termination from the squad and reversal of any scholarship received. Practices will be held five days per week at the time designated by the coaching staff, and every team member is required to attend. Other performances and appearances, on and off campus, will also be assigned, throughout the season by the head coach and must be attended by all student-athletes. Spirit Team members must perform at all games and events as determined by the Spirit Coordinator. I understand practice, athletic events, other events and/or the season is not over until I am released by the head coach. All student-athletes are expected to be present, on time, and functional for the entirety of an event or season, as determined by the coaching staff. Spirit Team members are responsible for attending functions and appearances as assigned by the spirit coordinator or head coach. If a team member must miss an assigned appearance for any reason that team member is responsible for finding a replacement. This must be done a minimum of two weeks in advance, and must be cleared with the

9 spirit coordinator. Some arrangements for replacements will not be honored, and must be fulfilled (ex. flight travel or playoff situations). Funding and Financial Obligations SFA provides team uniforms, but every Spirit Team member is expected to pay a rental/upkeep fee which will be added to each individual s fall and/or spring semester bill. Once uniforms have been issued, the care of all components of the uniform will be the responsibility of the Spirit Team member, and all components of this uniform must remain in an acceptable condition. SFA does not provide funding for camp, clothing, warm-ups, etc. Each student is expected to purchase the required items which will be added to each individual s fall semester bill. I understand that there will be no refunds for any payments made toward any cheerleading, dance or mascot fees if a squad member decides to quit or is removed from the squad due to disciplinary/academic reason. This applies not only to any monies paid into the cheer or dance programs, but also any fundraising that has been collected from team members. Once apparel, bags, warm-ups or other equipment is ordered, it becomes the individual s responsibility to pay off the balance. ATTITUDE Spirit Team members are expected to accept all responsibilities with a professional and positive attitude. Attitudes unbecoming of an ambassador of SFA, including, but not limited to, unsportsmanlike behavior and negative attitudes will not be tolerated. Spirit Team members are expected to remember their role as an ambassador for the university when dealing with students, faculty and staff members, teammates and coaching staff. Every team member should recognize themselves as a role model and set a positive example by showing respect and consideration for all members of the faculty, staff, administration and their property. As a representative of the university, every effort must be made to present both SFA, the Spirit Program and myself in the best light possible (ex. Facebook, Twitter, and other social networks). All Spirit Team members must be aware that all actions have the ability to influence other s opinions on not only themselves, but also the entire Spirit Program and the university. APPEARANCE Females: I will wear my hair as determined by the coaching staff. Males: I will wear my hair neatly groomed for all appearances. I will keep my facial hair well maintained and shaved to the discretion of the spirit coordinator for all performances and appearances. Full beards will not be allowed by any team member, with the exception of the mascot. (Goatees are allowed for cheer males). I will keep my hair color consistent with a collegiate image. No unnatural colors or patterns, including but not limited to, bright red, blue, purple, stripes, polka dots, etc. I will keep my hairstyle consistent with a collegiate image. No extreme hairstyles, including, but not limited to, mohawks, cornrows, shaved designs, etc. will be acceptable. I will not get any piercings that will either hinder my performance or that cannot be immediately taken out in the case of a performance. If the piercing already exists, I understand that I must take out all jewelry before participating in all appearances, practices and performances. I will not get any tattoos that would not be able to be covered by the uniforms provided by SFA. In the event a member possesses a tattoo that is not covered by uniforms provided, all student-athletes will be required to have appropriate covering. Appropriate covering will be determined by the Spirit Coordinator.

10 I realize that I have a right to personal appearance, but as a member of this organization, I will follow the rules set forth by the spirit coordinator so that the uniformity and appearance of the SFA Spirit Teams will be collegiate at all times. If I have any questions concerning what would compromise the collegiate image of the team, I must discuss the decision with Coordinator of Spirit Programs, T.J. Maple, and abide by the agreement reached. I have read the Stephen F. Austin State University Spirit Program Commitment Agreement. By signing this form, I understand that I will be held accountable under the rules and commitments set above to the SFA Spirit Program for the season. Failure to adhere to these guidelines may result in termination from the squad, reversal of any scholarship, formal warnings within the Spirit Office, referral to the Office of Student Rights and Responsibilities, and/or any other consequences deemed necessary by the coaching staff and assistant director of Student Affairs Programs. Name Signature Date

11 STEPHEN F. AUSTIN STATE UNIVERSITY WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT 1. In consideration for participating in the SFA Spirit Teams Event on the SFA campus, and other valuable consideration, I hereby RELEASE, WAIVE, DISCHARGE AND CONVENANT NOT TO SUE Stephen F. Austin State University (SFA), the Board of Regents, the State of Texas, their officers, servants, agents, and employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES, or otherwise, while participating in such activity, or while in, on or upon the premises where the activity is being conducted or in transportation to and from said premises. 2. To the best of my knowledge, I can fully participate in this activity. I am fully aware of risks and hazards connected with the activity, including but not limited to the risks as noted herein, and I hereby elect to voluntarily participate in said activity, and to enter the abovenamed premises and engage in such activity knowing that the activity may be hazardous to me and my property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such an activity, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise. 3. I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES from any loss, liability, damage or costs, including court costs and attorney s fees, that may incur due to my participation in said activity, WHETHER CAUSED BY NEGLIGENCE OF RELEASEES or otherwise. 4. It is my express intent that this Release and Hold Harmless Agreement shall bind the members of my family and spouse (if any), if I am alive, and my heirs, assigns and personal representative, if I am not alive, shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Texas. 5. I UNDERSTAND THAT THE UNIVERSITY WILL NOT BE RESPONSIBLE FOR ANY MEDICAL COSTS ASSOCIATED WITH AN INJURY I MAY SUSTAIN. 6. I further agree to become familiar with the rules and regulations of the University concerning student conduct and not to violate said rules of any directive or instruction made by the person or persons in charge of said activity and that I will further assume the complete risk of any activity done in violation of any rule or directive or instruction. 7. I also understand that I should and am urged by SFA to obtain adequate health and accident insurance to cover any personal injury to myself, which may be sustained during the activity or the transportation to and from said activity. 8. I ALSO UNDERSTAND THAT THE PARTICIPANTS ARE INDIVIDUALLY RESPONSIBLE FOR DAMAGE TO THE FACILITIES AND THE ATTENDING SPONSOR SHALL BE RESPONSIBLE FOR SUPERVISION OF PARTICIPANTS ATTENDING WITH SAID SPONSOR. SFA IS NOT RESPONSIBLE FOR SUPERVISION OF PARTICIPANTS. POSSIBLE INJURIES WHICH MAY OCCUR There are risks involved when participating in the following sports program offered. SFA Spirit Teams Event on the SFA campus. Some of the possible injuries and bodily harm that can occur through participation in the programs are listed below. This list is provided to make the prospective participant aware of the possibilities of injuries that may be sustained, but is not an all-inclusive list. The individual is completely responsible for his/her own safety and health. POSSIBLE INJURIES: strains, sprains, pulls, tears, cramps, infection, rashes, vomiting, bruises, contusions, wounds (abrasions, incisions, lacerations, punctures, avulsions), insect bites, dislocation, blisters, nosebleeds, broken bones, fractures, choking, respiratory or heart failure, heat exhaustion, heat stroke, fainting, nerve damage, shock, paralysis, concussion, and in an extreme case-death. BODY AREAS WHICH MAY BE AFFECTED OR INVOLVED IN SPORTS INJURIES: head, face, eye, ear, jaw, teeth, mouth, neck, nose, chest, abdominal, back, arms, elbow, hands, fingers, wrist, shoulders, genital organs, scalp, bones, leg, knee, hip, ankle, feet, toes, internal organs, nerves, muscles, ligaments, cartilage, joints, tendons, spinal cord, arteries, veins, and brain. This waiver will be signed by the participant to and will be in effect for all practices, clinics, and any other SFA Spirit Team Events.

12 I/My child have reviewed the above information and are aware of the risks in participating in sports programs and the possible injuries, which may occur. I/My child freely and voluntarily agree to participate in any and/or all of the activities listed here which are offered in the SFA Spirit Teams Event on the SFA campus. I also understand that this release is valid for the entire season, and includes all events hosted by the SFA Spirit Teams. IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent, and I execute this Release for full, adequate and complete consideration fully intending to be bound by same. IN WITNESS WHEREOF, I have here unto set my hand on this day of, 20. Participant Parent s Signature (if under 18 years old) MEDICAL TREATMENT PERMISSION FORM Student s Name I,, hereby give my permission, consent and authorization for any medical treatment deemed necessary by a hospital or physician. I appoint the event coordinator and/or director my lawful agent with power to authorize and consent to the administration of medical treatment during the aforementioned event. Home Phone ( ) Alternate Phone ( ) Health Carrier: Policy No.: Other Emergency Contacts: Please list all allergies, restrictions or health exceptions: This form should be properly signed and turned in at the time of registration. In case of such accident or illness, I give permission for medical treatment to be given to me (or my child) as deemed appropriate. I will assume responsibility for any medical treatment as deemed appropriate. I will assume responsibility for any medical bills incurred on my (or my child s) behalf. Student Signature Parent (if Participant is under 18 years of age or a dependent on parent s insurance and taxes for the period of the event) I, the participant, (if 18 years or older) or my child (if under 18) have been examined by a family physician, and is physically able to participate in the SFA Spirit Teams Event on the SFA campus. Date Participant Signature