2018 EAST/WEST ALL-STAR FOOTBALL GAME August 4 th, 2018 Baker City, Oregon

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1 2018 EAST/WEST ALL-STAR FOOTBALL GAME August 4 th, 2018 Baker City, Oregon Once a year, Oregon's best and brightest senior football players and cheerleaders from the 1A/2A/3A/ 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. Strong legs run, so weak legs may walk. 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) Selection Process 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

2 cheerleaders for the game. Applications may be found on the OCCA website under Special Events, Shrine Game. Completed Applications are due by (must be postmarked by) March 10 th, 2018 (or due March 15 th if ed). The football players who are selected will be 2018 graduates; we encourage your current senior cheerleaders to apply. The Shrine Cheerleading team is open to all 2018 graduates. If we do not have enough current graduates to fill the team, the team will be open to Class of 2019 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 $200 in sponsorships from local businesses or private donors. Sponsors will be featured in the game day program. Once you have been selected, specific information will be sent regarding this process. To participate in the game, a sponsorship is REQUIRED by all cheerleaders. Our coordinators will assist all athletes with this process. The sponsorship assists with all cheerleader expenses and serves as a donation to the hospital. 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. Shrine Team members should be outgoing, well-spoken and comfortable in sensitive situations. Athletes who are leaders in the classroom, school and community. We want talented all around cheerleaders as being selected to cheer at this event is an honor and will always be treated as such. You will serve as an ambassador for the game. The number of applicants continues to grow every year. Please understand that we may not be able to select all applicants from one school. Priority will be given to 2018 graduates. We do our best to include as many schools as possible and try to name at least one athlete from each school that has applied. Required Dates Cheerleaders must be available for the dates listed below, no exceptions will be allowed. If you are not fully available during the dates below, please do not apply for the team. The ONLY day you may miss is August 5 th as this is just a travel day home from Baker City, athletes may leave following the game on the 4 th. However, game time is 7:00pm, late night travel is HIGHLY discouraged. July 26 th and 27 th - Hospital Visit and Choreography August 2 nd -5 th - 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 Melissa Gemmet OCCA East/West All-Star Football Game Coordinator Head Coach, Cottage Grove High School Melissa.hatling@hotmail.com (Call or Text)

3 2018 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 2018 GRADUATE CLASS OF 2019 Attach a 3x5 high quality picture to your application. **Please attach a picture of yourself in your cheerleading uniform. All photos which are deemed inappropriate by the Shriners Organization will result in the applicant being disqualified from team consideration. Please place an X if you: A/2A/3A or 4A OCCA All-State Team Member Participant in the OCCA All State Individual Competition. Participant in the OCCA All State Stunt Competition T-shirt Size: Cheerleading: (Please list your cheerleading experience) Cheerleading Achievements:

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: TOP BASE BACK BASE FRONT BASE **You may NOT be performing the stunting position you are used to performing. We need team members who are willing to learn and perform the position asked of them and who will just go with the flow ** Academic Achievements: Community Activities/Achievements: High School Coach Signature (REQUIRED): Coach Comments:

5 Important criteria to consider before applying for the game: Transportation is NOT provided to the choreography camp, hospital visit or Baker City. We will make every effort to encourage carpools for athletes who live in the same geographic area but it is not guaranteed. Jewelry will NOT be allowed during any pre-game performances, halftime performance, choreography, during the game, or in the parade. Please be aware that if you are planning to get a new piercing, it must be removed for all activities or you cannot participate. The required dates of July 26 th and 27 th and August 2 nd -5 th are not negotiable. If you are unable to attend any of the required activities and be fully available, please do not apply for the game. The only exceptions will be made for the August 5 th date and must be approved by the OCCA Shrine Game Coordinator. If you are not comfortable or mature in sensitive situations, such as visiting the Shriners Hospital for Children, this event is not for you. We are looking for athletes who are committed to the cause, who will be outgoing with the Shriners and will act appropriately at all times. Most of our selected athletes will be 18 at the time of the game. You are not chaperoned during the evening hours. The head coaches and OCCA Shrine Game Coordinator are responsible for you during the Shriners activities, game, pre-game, practices, choreography, and hospital visits. However, the evenings are free time. Many of our past teams use this time for team bonding whether it be swimming in the hotel pool or exploring Baker City. This is not a time to use poor judgement or break the law. You are representing your school, cheer program and yourselves, as well as the Shriners Organization when you are in public. If you are not capable of behaving responsibly and take your role seriously, please do not apply for this event. Coaches and the coordinators reserve the right to send anyone home who does not comply. A picture of each applicant must accompany the application. The photo must be a professional looking photo of the applicant in uniform. Photos that are not professional and in uniform will lead to automatic dismissal of the application and you will not be selected for a team. You should be in good health and able to perform all duties in regards to cheerleading. If you have an injury that will prevent you from participating fully, please do not apply for this event. The game takes place during August and Baker City tends to be very warm. If you are unable to perform in this environment, take this into consideration before you apply. We are outside for most of our activities. This team is usually comprised of graduates. The football players are also graduates. Fraternizing with the football team is not allowed and for the most part, the teams do not attend the same events with the exception of the game and a Shriners BBQ for all of the families. Many of our past participants share a bond years after their game. This is the best way to complete your high school cheerleading career. Many of our participants can tell you story after story about their experience and you will never regret participating. We have photo albums on our Facebook page, check them out! We have had a lot of fun over the years and all while helping some pretty extraordinary and special kids.

6 CHEERLEADERS and PARENT/GUARDIAN CONSENT FORM Please print clearly when completing form TO SHRINERS HOSPITAL OREGON EAST-WEST ALL-STAR COMMITTEE We hereby give our consent for the participation of our daughter/son Name of cheerleader As a cheerleader in the 66th Annual Shriner s Hospital Oregon East-West Football Game to be played at The Baker City High School Stadium, Baker City, Oregon on August 4th, 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 her/him to a local doctor or hospital for an examination and/or treatment? Yes No Family Doctor: * Completed, Signed Licensed Physician s Form is also required* Phone Number: Address: Coaches Name: Phone Number: Please Print Legibly: Cheerleader s Full Legal Name: Known by: Address: City: Zip Code Mailing Address [if different]: Home Phone: Cell Phone: Address: FAX: Birthday: Mo Day Year Cheerleader s Signature Date: Parent/Guardian Name: [Please Print] Parent/Guardian Signature: Date: Address if different from information given by cheerleader: Address:

7 East-West Shrine All-Star Cheerleaders 2018 Program Information Sheet [Be sure to print all information clearly.] Name: School: Town: Parent/Guardian Name: Cheerleading history: Other honors : GPA: Class of Community Activities: College/Vocational Plans: Participants must provide a professional high resolution photo. The photo will be used for the program, website and US Bank display. Photo must accompany application and all selected participants will be required to send their photo by to Heidi Lagao, kolshots@gmail.com upon selection. Submitted photo must be of the participant in cheerleading uniform. Any photos that are deemed inappropriate will lead to automatic disqualification from the selection process.

8 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 coverage ceases. This policy covers accidents sustained by duly registered participants in the game or related activities. It does not cover any illness, diseases or naturally caused ailments unrelated to an accidental injury. To properly register the cheerleader/coach for insurance coverage, the following information is required. To expedite and avoid potential confusion, please complete all the information requested. Insurance Company: Policy Number: Name of Policy Holder: Cheerleader/Coach Full Name: Cheerleader/Coach Date of Birth: Parent/Guardian Signature: Parent/Guardian Phone Number: Parent/Guardian Address: Parent/Guardian Address: City: Zip Code:

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10 2018 Shrine East-West All-Star Football Game All-Star Cheerleader Physician Release Form [Signature of a licensed 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 26 th through August 4 th, 2018 in Baker City Oregon. The main cheerleading activities will be on August 4 th, 2018 at the East-West All Star Football Game Licensed Physician s Signature Address Date Phone Number

11 Please send completed application to: Applications must be postmarked by March 10 th, 2018 (or received by March 15th if ed) to be considered for the 2018 team. Mail: Heidi Lagao Shriners Organization / Cheerleading Coordinator 523 N Fremont Street Sisters, OR kolshots@gmail.com Include your name and Shrine Application in the subject line. APPLICATION CHECKLIST All forms MUST be complete in order to be considered for the 2018 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. Complete Application High resolution picture in cheerleading uniform. Cheerleader/Parent Consent Form Cheerleader Information Sheet Cheerleader Insurance Form Model Release Physician Release Form Physician Release 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. Questions? Please contact: Melissa Gemmet OCCA Shrine Game Coordinator (call or text) Melissa.hatling@hotmail.com

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