Veterans High School

Transcription

1 Veterans High School Football/Basketball/Competition Cheerleading Tryout Packet 2014 Tryout Dates: March Competition March 24, 25 Football March 26,27 Basketball 3:30-5:30 If you have any questions regarding the tryout packet information, please contact: Coach Fincher

2 Veterans High School Football/Basketball/Competition Cheerleading 2013 TRYOUT APPLICATION Athlete Name Current Grade Mailing Address Home Phone ( ) Cell Phone ( ) School Attended Birthday / / Parent/ Guardian Cell ( ) My goals as a competitive cheerleader are My goals as a football cheerleader are I plan to accomplish my goals by Athlete s Signature Parent/Guardian Signature Date Date

3 Veterans HIGH SCHOOL ATHLETIC DEPARTMENT MEDICAL FORM Name: Parent s Name Address: Home Phone #: Date of Birth: Family Physician Grade ( year) Sport(s) expected to participate in: MEDICAL HISTORY 1. Sports participated in previously: 2. Previous Sports Injury: daeh ڤ ytimertxe reppu ڤ kcen ڤ ydob ڤ redluohs ڤ ytimertxe rewol ڤ 3. Previous fracture/dislocation/separation: 4. Previous Surgery (list all with dates): 5. Do you take medications? (for any reason, please list names): 6. Please list allergies to any and all medications: 7. Have you ever had or do you now have: YES NO YES NO Concussion ڤ ڤ Tuberculosis ڤ ڤ Headache ڤ ڤ Heart Trouble ڤ ڤ Heat Illness ڤ ڤ Rheumatic Fever ڤ ڤ Dizziness ڤ ڤ Chest Pain ڤ ڤ Convulsions/Seizures ڤ ڤ Ulcers ڤ ڤ Epilepsy ڤ ڤ Allergy ڤ ڤ Vision Trouble ڤ ڤ Diabetes ڤ ڤ Hearing Trouble ڤ ڤ Back Ache ڤ ڤ Nose Bleed ڤ ڤ Hernia/Rupture ڤ ڤ Asthma ڤ ڤ Mononucleosis ڤ ڤ If the answer to any is yes, explain: Do you wear: Glasses: Yes ڤ No ڤ Contacts: Yes ڤ No ڤ Do you have: False teeth: Yes ڤ No ڤ Plates: Yes ڤ No ڤ Braces: Yes ڤ No ڤ AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT: I hereby give permission for emergency treatment by the team physician and/or trainer or by an emergency physician of conditions arising from participation in athletics. This will include, but not limited to, initial diagnostic x-rays and such other procedures as the physician may see necessary for the preservation of health. Above information is correct. I also give permission for school athletic physician or designee to examine my son/daughter. Date Parent s Signature

4 VETERANS HIGH SCHOOL ATHLETIC DEPARTMENT EMERGENCY INFORMATION FORM Athlete s Name Address: Home Phone #: Sports Expected to Participate in: Parent/Guardian Information Father: Work Phone: Cell or other Phone: Mother: Work Phone: Cell or other Phone: Name of Primary Insurance: Policy number In case of an emergency, contact above persons or contact: Name/relation: Phone Number: In case of an emergency involving my/our child,, and no contact indicated on this form can be reached, I/we give permission to school personnel to arrange for the athlete to be taken to a local emergency room and I/we authorize the hospital medical personnel to administer any necessary medical care. Date Parent/Guardian Signature

5 VETERANS HIGH SCHOOL CHEERLEADING Acknowledgement of Warning ACKNOWLEDGEMENT OF WARNING BY ATHLETE I,, hereby acknowledge that I have been properly advised, cautioned and warned by the proper administrative and coaching personnel of the Houston County School District, that by participating in the sport of CHEERLEADING I am exposing myself to the risk of serious injury, including, but not limited to, the risk of sprains, fractures, and ligament and/or cartilage damage which could result in temporary or permanent, partial or complete, impairment in the use of my limbs; brain damage; paralysis, or even death. Having been so cautioned and so warned, it is still my desire to participate in the above sport and should I choose to participate in the above sport, I hereby further acknowledge that I do so with full knowledge and understanding of the risk of serious injury to which I am exposing myself by participating in the above sport. SIGNATURE OF ATHLETE DATE ACKNOWLEDGEMENT OF WARNING BY PARENTS We/I, the parent(s) of acknowledge that we/i have been properly advised, cautioned and warned by the proper administrative and coaching personnel of the Houston County School District, that by participating in the sport of CHEERLEADING my/our child will be exposed to the risk of serious injury, including, but not limited to, the risk of sprains, fractures, and ligament and/or cartilage damage which could result in temporary or permanent, partial or complete, impairment in the use of his/her limbs; brain damage; paralysis, or even death. Not withstanding such warnings, and with full knowledge and understanding of the risk of serious injury to our/my child named above which may result, we/i give our full consent to participating in the sport of CHEERLEADING. SIGNATURE OF PARENT/GUARDIAN DATE

6 VETERANS HIGH SCHOOL INSURANCE WAIVER AND VERIFICATION FORM STUDENT NAME All students in the Houston County School System must show proof of insurance in order to participate in any athletic activity. If the student s parents do not have coverage, Houston County can provide coverage. Please contact the front office for pricing and additional information about school insurance. It is important that you understand that this policy is an excess policy; i.e., your own family or company policy must pay first. I hereby relieve the Houston County Board of Education and Houston County High School Athletic Department and its employees of any financial responsibility or liability for injuries which may occur during the practice, competition, or travel to or from athletic events and/or contests. Name of Insurance Company Policy Number Guarantor Parent/Guardian s Signature Date