THE STANDARD. DELAWARE S PREMIER ALL STAR CHEERLEADING PROGRAM

Transcription

1 THE STANDARD. DELAWARE S PREMIER ALL STAR CHEERLEADING PROGRAM

2 GREETINGS FROM OUR OWNERS! DEAR NEW AND RETURNING FAMILIES, We are excited for season eleven of Tristate Athletics, as we go into our second full-season as owners. We are prepared along with our staff to continue to build on the past successes and working to succeed all expectations. Beginning a new season is always an exciting, sometimes intimidating, and fun process. We want to ensure that everyone is fully prepared for tryouts, and the 2018/2019 season. Tristate Athletics tryout process has been adjusted for the new season, so ALL athletes will be experiencing something new this year! All athletes will be taught the Tristate approach to jumps, learn the expectations of tumbling skills, as well as learn a short dance sequence to gauge choreography. Each athlete will have the opportunity to meet our staff and begin making friends with returning and new athletes. Remember, there are many key elements that go into a team placement. Keep in mind that Tristate Athletics teams are created to compete at the highest level locally, regionally, and nationally. While tumbling is an important part of all star cheerleading, it is not the only factor used in determining an athletes team placement. We are very aware that each athlete needs to be an asset in some facet to the team s success, because of this, team placements will not be based on request, carpool, a single skill assessment, practice availability, or previous team assignment. Also new this season, we will announce team placements directly after tryout completion on May 21st. At this time, we will also set the upcoming season s practice schedule for each team. During the following 2-3 weeks (well in advance of the July Skills Clinic), minor adjustments will be made to team rosters to ensure we field the most competitive teams. We re excited to begin the season with you! Brad Gilbert & Scott Ralph, Owners REGISTER ONLINE TRYOUT CLINIC DATES EVALUATION DATES MONDAY MAY 14, 2018 AGE :00-7:30 PM AGE :00-8:30 PM TUESDAY MAY 15, 2018 AGE :00-7:30 PM AGE :00-8:30 PM WEDNESDAY MAY 16, 2018 AGE :00-8:30 PM THURSDAY MAY 17, 2018 AGE :00-9:00 PM **ATHLETES ATTEND ONE CLINIC **ATHLETES ATTEND ONE CLINIC **ATHLETES ATTEND AT SCHEDULED TIME **ATHLETES ATTEND AT SCHEDULED TIME TRYOUT CHECK LIST: COPY OF BIRTH CERTIFICATE HEADSHOT / PHOTO (NEW ATHLETE) TRISTATE WAIVER COPY OF INSURANCE CARD TRYOUT APPLICATION DEBIT AUTHORIZATION FORM DE STATE CONCUSSION FORM DCCA COMPETITION WAIVER MAKE-UP OR PRIVATE EVALUATIONS CAN BE SCHEDULED MAY 9TH, 10TH, 12TH OR 13TH TRYOUT FEE $50.00 NEW ATHLETES TRYOUT FEE $20.00 RETURNING ATHLETES

3 SAVE THE DATES. FULL SEASON CALENDAR OVERVIEW FOR MAY 2018 JUNE 2018 JULY 2018 AUGUST 2018 SEPTEMBER 2018 OCTOBER 2018 NOVEMBER 2018-MAY 2019

4 PROGRAM COSTS AUTO DEBIT FEES GYM FEES THESE FEES ARE AUTO-DEBITED USING YOUR CARD ON FILE MULTIPLE CHEER ATHLETE FAMILIES TRISTATE ATHLETICS LOYALTY DISCOUNT RETURNING FAMILIES REFERRAL INCENTIVE REGISTRATION FEE Each athlete will pay a yearly registration fee for participation at Tristate Athletics. This fee will auto-debit from the card on file for your account on June 1, NON AUTO DEBIT FEES UNIFORM FEE You will receive a discount off of your monthly gym fees if you have multiple athletes in our full year program. You will receive 25% off of your 2nd Athlete s Gym Fees, and 50% off your 3rd or More Athlete s Gym Fees. Any athlete that has participated, and completed 3 or more consecutive seasons in our full year program will receive a 10% discount on their Gym Fees. Any athlete that has participated, and completed 5 or more consecutive seasons in our full year program will recieve a 15% discount on their Gym Fees. A $50.00 referral credit will be applied to your account for each athlete that you bring to Tristate Athletics, for participation in the 2018/2019 season. The credit will be applied towards your Gym Fees in December Be sure the referral indicates your name on their application. THESE FEES MUST BE PAID AT THE DESK IF NEEDED (ATHLETES ARE REQUIRED TO PURCHASE A NEW UNIFORM COVER UP T-SHIRT EVERY YEAR) There is a uniform fee of $ for your competition uniform and t-shirt cover up. Uniform payments are NOT AUTO-DEBIT, and must be paid in the office. Payments can be made in two equal installments by July 15th and August 15th. *Fittings will be in Summer FIXED FEES There are multiple expenses for the full year program that are not outlined in above categories. We combine these expenses into fixed fee payments. Fixed fees include: competition performance cosmetics, competition uniform hair bow, professionally edited competition music, routine choreography, competition registration fees, skills clinics, USASF Registration Fee (annually required from the governing body of All Star Cheerleading), banquet tickets for athletes, and numerous other expenses incurred throughout the season. The fixed fee expense varies depending on placement of the athlete. Fees for the season can range from $ $ on a scheduled payment plan or discounted for payment in full. Fees are paid in either (Full) or (5) month installments through the first half of the season from July through November. Fixed Fees are NOT AN AUTO-DEBIT from the card on file, and must be paid manually in the office. You will be notified of your athlete s fixed fee expense based on their team placement. CHOREOGRAPHY / PRACTICE APPAREL FEE We will be placing our order for choreograhy/practice apparel and Nfinity Shoes for all athletes early to ensure timely delivery of items. Athletes will be fitted for apparel, and sneakers in June. Payment in full of $ for these items are due by June 15th. This payment is NOT AN AUTO-DEBIT from the card on file for your account, and must be paid manually in the office. This fee is non-refundable.

5 FREQUENTLY ASKED QUESTIONS WHAT HAPPENS AT EVALUATIONS? WHAT IS SOFT TEAM PLACEMENTS? WHAT IS CONSIDERED IN MAKING TEAM PLACEMENTS? WHY DO I NEED A CREDIT CARD / DEBIT AUTHORIZATION FORM?

6 WHEN WILL MY PRACTICES BE SCHEDULED? WHO WILL BE MY ATHLETE S COACH? WHAT LEVEL IS MY ATHLETE? To be considered at a level, athletes should have mastered all listed skills with consistency and proper technique. Athletes will be placed on teams with LIKE-MINDED and LIKE-SKILLED individuals. When attending evaluations please keep in mind, your athletes cheer age is based on their age on Aug. 31st, 2018 **Example of tumbling requirement/recomendations (outlined below). LEVEL MINIMUM REQUIREMENTS ADVANCED RECOMMENDATIONS LEVEL 1 NO EXPERIENCE NECESSARY! FRONT WALKOVER, DOUBLE BACK WALKOVER, BACK WALKOVER SWITCH LEG LEVEL 2 SOLID STANDING BHS, RUNNING PASS WITH MULTIPLE BHS BACK WALKOVER BHS, SPECIALTY PASSES ENDING IN ROUND-OFF BHS (FRONT-WALKOVER, ETC ) LEVEL 3 SOLID JUMP INTO 2 STANDING BHS, STRONG ROUND-OFF BHS TUCK SPECIALTY PASSES ENDING IN TUCK (FRONT-WALKOVER, PUNCH FRONT, ETC ), STANDING 3 BHS LEVEL 4 LEVEL 5 LEVEL 5 WORLDS STANDING 2 BHS TO TUCK, STANDING TUCK, STRONG ROUND-OFF BHS LAYOUT ROUND-OFF BHS FULL (OR DOUBLE FULL FOR J5), JUMP TUCK COMBINATION, STANDING 2 BHS TO LAYOUT OR FULL 3-JUMPS TO TUCK, SPECIALTY PASS ENDING IN A FULL OR RUNNING DOUBLE FULL, STANDING FULL, 1-BHS TO FULL, 2-BHS TO FULL OR STANDING PASS ENDING IN DOUBLE FULL SPECIALTY PASSES ENDING IN LAYOUT (FRONT-WALKOVER, PUNCH FRONT, WHIP THROUGH, ETC ), TRIPLE JUMP HANDSPRING TUCK SPECIALTY RUNNING PASS ENDING IN A FULL (FRONT-WALKOVER, PUNCH FRONT, WHIP THROUGH, ETC ), STANDING SPECIALTY PASS ENDING IN A LAYOUT OR FULL SPECIALTY RUNNING PASS ENDING IN A DOUBLE FULL, JUMP INTO 1 BHS FULL, TOE FULL We will follow the USASF age grids released for the season. There is min and max ages for all age groups, and varying levels. Reminder: Team placements will not be based on request, carpool, single skill assessment, practice availability, or previous team assignment. Please keep in mind we are continually working to field the strongest teams possible. WHAT IS THE COMPETITION SCHEDULE? I STILL HAVE MORE QUESTIONS.. FREQUENTLY ASKED QUESTIONS

7 ATHLETE APPLICATION ATHLETE NAME ADDRESS DATE OF BIRTH AGE ATHLETE ATHLETE CELL # GRADE AS OF AUGUST 31, 2018 ATHLETE T-SHIRT SIZE (BELLA BRAND) YS YM YL AXS AS AM AL AXL AXXL AXXXL REFERRED BY PARENT NAME CELL # WORK # PARENT PARENT NAME CELL # WORK # PARENT PLEASE LIST ANY AND ALL PRE-EXISTING INJURIES, MEDICATIONS, OR MEDICAL ISSUES WE SHOUL D BE AWARE OF. PLEASE LIST ANY ALLERGIES YOU HAVE EMERGENCY CONTACT NAME PHONE NUMBER WHEN SCHEDULING TEAMS FOR SESSIONS WITH OUR VISITING GUEST INSTRUCTORS AND CHOREOGRAPHERS, WE ARE ABLE TO ARRANGE THE SCHEDULE TO AVOID AS MANY CONFLICTS AS POSSIBLE. WHILE THIS IS NOT GURANTEED, WE WILL DO OUR BEST TO MINIMIZE ABSENCES. A REMINDER, OUR DATES ARE PUBLISHED WELL IN ADVANCE, ATHLETE S SHOULD MAKE A STRONG EFFORT TO AVOID TRAVEL DURING PRE-PLANNED DATES. DEPARTURE DATE RETURN DATE IS THIS TRIP LOCAL? DEPARTURE DATE RETURN DATE IS THIS TRIP LOCAL? DEPARTURE DATE RETURN DATE IS THIS TRIP LOCAL?

8 ATHLETE TRYOUT FORM THIS PAGE IS TO BE COMPLETED BY ATHLETES, WITH HELP OF A PARENT OR GUARDIAN. ATHLETE NAME DATE OF BIRTH AGE ATHLETE ATHLETE CELL # GRADE AS OF AUGUST 31, 2018 PREVIOUS CHEERLEADING EXPERIENCE (NO EXPERIENCE IS REQUIRED, PLEASE LIST LOCATION & YEARS, COMPETED LEVELS W/POSITION) ` I IDENTIFY MYSELF AS A: BACKSPOT MAIN BASE SECONDARY BASE TOP PERSON CIRCLE ONE MY SECONDARY (OR NEXT) POSITION WOULD BE: BACKSPOT MAIN BASE SECONDARY BASE TOP PERSON CIRCLE ONE STANDING TUMBLING SKILLS (PLEASE LIST ALL SKILLS THAT ARE MASTERED): RUNNING TUMBLING SKILLS (PLEASE LIST ALL SKILLS THAT ARE MASTERED): MY GOAL IS TO MAKE A LEVEL TEAM AT TRISTATE ATHLETICS. MY GOALS FOR THE SEASON INCLUDE: ADDITIONAL INFORMATION YOU WOULD LIKE US TO KNOW ABOUT YOU:

9 TRISTATE ATHLETICS / TRI-STATE CHEERNASTICS INC. OF NEW CASTLE RELEASE FORM ASSUMPTION OF RISK, RELEASE, INDEMNIFICATION, AND COVENANT NOT TO SUE THIS AGREEMENT is entered into this DATE day of, MONTH 2018 by and between TRISTATE ATHLETICS/TRI-STATE CHEERNASTICS, INC. OF NEW CASTLE, a Delaware Corporation and parent (if participant is under 18) or self (participant is over (18). In consideration of TRISTATE ATHLETICS/ TRI-STATE CHEERNASTICS allowing the hereinafter-named participant(s) to participate and/or enroll in a program and/or to use the equipment and facilities of TRISTATE ATHLETICS/TRI-STATE CHEERNSATICS and for the other good and valuable consideration, the undersigned, intending to be lawfully bound, hereby covenant and agree as follows: 1. CERTIFICATION OF AUTHORITY I/We, the undersigned, hereby warrant that I/we are the participant(s) or custodial parent(s) and/or lawful guardian(s) of the hereinafter-named participant(s) and have lawful authority to make and execute this agreement for myself/ourselves and for and on behalf of the hereinafter-named participant(s) (PLEASE PRINT): Participant(s) Name: Birth-Date(s): Address: City, State, Zip Phone: 2. ACKNOWLEDGEMENT AND ASSUMPTION OF RISK - I/We hereby acknowledge that I/We are aware that the above named participant(s) will be engaging in physical exercise and activities involving various gymnastics and acrobatic equipment and facilities, coordination events, fitness training, and sports which inherently and in their very nature could cause injury to named participant(s). Injuries including, but not limited to muscle strains, ligament sprains, fractures, paralysis or death. Fully recognizing the potential risks, I/We hereby assume all risks that such injury(s) may result. 3. WAIVER AND RELEASE I/We hereby waive any and all claims, past, present, or future, known or unknown of any kind or nature, for personal injury (including death) arising out of or connected with the herein-above-named participant(s) participation at TRISTATE ATHLETICS / TRI-STATE CHEERNASTICS facilities (or elsewhere under TRISTATE ATHLETICS /TRI-STATE CHEERNASTICS control or supervision), I/We hereby release TRISTATE ATHLETICS/TRI-STATE CHEERNASTICS, it s officers, directors, agents, and employees from any and all such claims. 4. COVENANT NOT TO SUE I/We hereby covenant and agree not to sue, nor assist any other person or legal entity, in suing, TRISTATE ATHLETICS/TRI-STATE CHEERNASTICS, it s officers, directors, agents, and employees or on account of any such claim described in paragraph No. 3 above. 5. INDEMNIFICATION I/We hereby covenant and agree to hold harmless and indemnify TRISTATE ATHLETICS/TRI-CHEERNASTICS, it s officers, directors, agents, and employees described in Paragraph No. 3 hereof made by or on behalf of any person or legal entity, including court costs, expert witness fees, and reasonable fees. 6. ACKNOWLEDGEMENT OF NO PHYSICAL EVALUATION BY TRISTATE ATHLETICS/TRI-STATE CHEERNASTICS I/We hereby acknowledge that TRISTATE ATHLETICS/TRI-STATE CHEERNASTICS will make no evaluation or recommendation as to whether or not the herein-above-named particiapant(s) is/are physically fit for any exercise activity, and that if such particiapant has any physical condition that may impact upon his/her ability to engage in these activities, and/or which condition may be aggravated or exacerbated by these activities, it is my/our responsibility to obtain a physician s statement describing any limitation to participate in the programs, activities, and/or to make use of the equipment and facilities. I/We further acknowledge that it is always advisable to consult with a physician prior to allowing said student to undertake any physical exercise program. 7. SEPARABILITY If any section, paragraph, sentence, or clause of the Agreement is determined or declared to be invalid or unenforceable by any court of competent jurisdiction, the remainder hereof shall remain in full force and effect. 8. BINDING EFFECT This agreement shall be binding upon the parties hereto, their administrators, successors, and assigns. 9. GOVERNING LAW This agreement shall be governed by the laws of the State of Delaware notwithstanding the fact that one or more parties may now or later become a resident of another state. TRISTATE ATHLETICS/TRI-STATE CHEERNASTICS of New Castle By: Custodial Parent/Lawful Guardian Date: Self (participants over 18 years of age)

10 Tristate Athletics/Tri-State CheerNastics Inc. (302) M King Avenue New Castle, DE Debit & Credit Card Authorization I (we) hereby authorize Tristate Athletics/Tri-State CheerNastics, Inc., hereinafter called COMPANY, to initiate debit entries to my (our) account indicated below and the financial institution named below, hereinafter called FINANCIAL INSTITUTION, to debit the same to such account for payments to my account at Tristate Athletics/Tristate CheerNastics. I (we) acknowledge the origination of ACH transactions to my (our) account must comply with provisions of U.S. law. Gym Fees: Accounts will be debited on the first of each month, June through May, for monthly gym tuition fees using the primary card on file. If the primary card does not process for any reason, the secondary card will be processed for the monthly gym tuition fees. A $15.00 late fee will be applied to the account for any fees not paid by the 5th of each month. Fixed Fees: Fixed fees are to be paid in person by the 15th of each month, July through November. If your fixed fee is not paid by the 20th of the month, a $15.00 late fee will be applied and the card below will be charged the outstanding amount, plus 3% credit card fee. Account Updates: It is the responsibility of each individual to update their account information, on file in writing, as often as needed. NEW THIS SEASON: Option to have Fixed Fees Charged with Monthy Gym Fees for the first 5 months of the agreement June 2018-November I understand, that my fees will be combined and automatically billed on the first of each month (instead of the 15th when they are due at the desk). Any fees processed using a credit card (outside of Monthly Gym Fees) will be charged a 3% fee. Athlete s Name Primary Card Information Name on Card: Credit Card Number: Billing Address: Secondary Card Information Name on Card: Credit Card Number: Type of Card: Expiration Date: Billing Zip Code: Type of Card: Expiration Date: CVV: CVV: Billing Address: Billing Zip Code: I am opting into the OPTIONAL FIXED FEE CHARGE PROGRAM, AND ACCEPT THE 3% CREDIT CARD PROCESSING FEE ASSOCIATED WITH THIS SELECTION. INITIAL TO ACCEPT THE ABOVE OPTION, IF YOU DO NOT WISH TO OPT IN - DO NOTHING This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and manner as to afford COMPANY and FINANCIAL INSTITUTION a reasonable opportunity to act on it. (Print Individual Name) (Signature) (Date)

11 TRISTATE ATHLETICS FEE STRUCTURE AUTO-DEBIT USING CARD ON FILE AUTO-DEBIT USING CARD ON FILE NOT SUBJECT TO 3% CC FEE NOT SUBJECT TO 3% CC FEE TEAM AGE TRYOUT FEE (Once Annually) Includes T-Shirt Paid Prior to Tryout Fee is NOT Subject to 3% CC ANNUAL REGISTRATION (AUTO DEBIT FEE) Fee is NOT Subject to 3% CC CHOREOGRAPHY/PRACTICE APPAREL FEE (NOT AUTO DEBIT) (MAY OPT IN) 3% FEE FOR CREDIT CARD UNIFORM FEE New Athletes Uniform & Cover Up (2 Payments) (NOT AUTO DEBIT) (MAY OPT IN) 3% FEE FOR CREDIT CARD COVER UP T-SHIRT Returning Athletes ONLY NOT AUTO DEBITED MONTHLY TUITION Gym Fees June 1, May 1, 2019 (12 months) (AUTO DEBIT FEE) Fee is NOT Subject to 3% CC FIXED FEES (NOT AUTO DEBIT) (OPTIONAL OPT IN AUTO BILL NEW FOR 2018/2019) Pay in Full & Save, or Pay Monthly (5) Months July-Nov (see below payment schedule) All Fees Paid by Credit Card will incur an Additional 3% Fee Paid in Full 5 Month Installments MINI New Athletes $50.00 Returning athletes $20.00 June 1st $35.00 June 15th $ July 15th $ Aug 15th $ $25.00 $ Billed Monthly +$10.00 for Flyers Monthly July 15th $ OR July 15th $ Aug 15th $ Sept 15th $ Oct 15th $ Nov 15th $ YOUTH JUNIOR SENIOR New Athletes $50.00 Returning athletes $20.00 June 1st $35.00 June 15th $ July 15th $ Aug 15th $ $25.00 $ Billed Monthly +$10.00 for Flyers Monthly July 15th $ OR July 15th $ Aug 15th $ Sept 15th $ Oct 15th $ Nov 15th $ **PREP SEASON PACKET AVAILABLE LATE SUMMER **New for 2018/2019: Athletes designated a flyer, or at the request of a Tristate Coach, will attend an additional weekly flyer class. Beginning on Sundays in conjunction with Sunday Team Tumbling Schedule.

12 State Council for Persons with Disabilities Parent/Player Concussion Information Form Background: Delaware law requires athletes under age 18 and their parents to review and sign this sheet prior to participation in covered activities sponsored by a club, league or association. Covered activities include football, rugby, soccer, basketball, lacrosse, field or ice hockey, martial or combative sports, wrestling, volleyball, gymnastics, baseball, softball, and cheerleading. This signed form should be given to the sponsoring organization prior to participation, and, for multi-year activities, on a yearly basis. You can get detailed information about the law at our SCPD Website at What is a concussion? A concussion is a type of traumatic brain injury or TBI caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth. A concussion changes how the brain normally works. An athlete does not have to lose consciousness (black out) to get a concussion. A blow elsewhere on the body can cause a concussion even if an athlete does not hit his / her head directly. Signs and symptoms of a concussion: Concussions can affect children and teens differently. Below are common symptoms they might report or that might be observed. It can take days for symptoms to appear following the initial hit /fall. Experienced by Children and Teens Headache or pressure in the head Nausea or Vomiting Dizziness or balance problems Blurred or double vision Light or noise sensitivity Ringing in ears Difficulty concentrating or remembering Confusion Feeling slowed down Feeling sad, irritable, or more emotional Being tired, or a change in sleep Just not feeling right or feeling down Younger children may not be able to report symptoms, and so decisions should be based on adult observation. Observed by Parents, Coaches, or Teammates Loss of consciousness Appears dazed or confused Responds slowly / answers questions slowly Change in behavior, mood, or personality, including irritability or aggressive Can t recall events prior to or after the hit/fall Loses focus on current activities Moves clumsily/ Appears off balance Slurred speech Is more restless or appears more tired than usual Change in sleep pattern 1 P a g e

13 What should happen if my child/teen might have a concussion? The athlete must leave the game, practice or activity immediately. This is Delaware law and is in place to protect your child. They should not re-enter play until seen and evaluated by a physician. When in doubt, the athlete sits out. Remember, it is better to miss one game than to miss the whole season. If an athlete continues to play when he or she might have a concussion, there could be serious medical consequences, even death (Second Impact Syndrome). Also, if a concussion has occurred or is suspected the CDC advises that you ask your (child s/teen s) health care provider when they can safely return to other activities, e.g. school, drive a car and/or ride a bike. Athletes should not be left alone. Concussions can have a more serious effect on the young, developing brain-whose development extends into young adulthood. Be aware that sometimes athletes try to hide their symptoms so that they can stay in play. Have your child seen by a physician, even if symptoms resolve. Do not try to judge the severity of the injury yourself. To return to play: Delaware law requires that your child be seen and given medical clearance by a physician before return to play. Your physician may either complete a form or supply a letter certifying clearance. Provide the form or letter to the sponsoring organization. If the physician limits school-related activities like classwork, driver s education, gym and recess, you may wish to share the form or letter with the athlete s school. Additional websites: If you have additional questions regarding concussion or concussion management, we recommend the following websites: CDC Headsup Website CDC Concussion Information Moms Team Concussion Safety Brainline Organization I affirm: (1) I have read the above information; and (2) if the athlete could not independently read it due to reading ability, I have shared its key points with the athlete. Parent/Guardian signature Parent/guardian printed name Date I affirm: that I have read the above information or been told its key points by my parent/guardian. Athlete signature Athlete printed name Date 2 P a g e * We recommend printing and keeping a copy of this form for your records.

14 PARENT/GUARDIAN CONSENT AND LIABILITY My daughter/son has my permission to participate in the DCCA competition known as: I acknowledge and understand and agree that in taking part in this competition and related activities that there is a possibility of physical illness or injury and that the participant is assuming the risk of such illness or injury by participating. I give my permission to this competition, its coaches and any volunteers to take the necessary measures for my child to receive medical attention in case of any injury. As a condition for my daughter's/son's participation, I have agreed to release the school, coaches and all other parties concerned from any personal injury, theft and/or damages to my child or property, and I understand that the venue, coaches and all other parties concerned will not be held responsible by me for the above. I acknowledge that my child may be videotaped or photographed and that, once taken, such videos and photographs may be published at any time, in any form of media. I release the host from any and all liability arising out of or in connection with the above-described activities. THIS FORM WILL NOT BE ACCEPTED WITHOUT BEING SIGNED BY THE PARTICIPANT, THE PARENT/GUARDIAN AND COACH. Team/Organization Name: Division: Name of Participant: Age: Birth Date: Emergency Contact: Cell Phone: Participant's Signature: Parent/Guardian's Signature: Coach's Signature: Date: Date: Date: DCCA-Qualifier Packet