Checklist:

Completed and signed application Signed liability waiver (parents signature if under 18 years) Front and back copy of health insurance card Copy of Current Physical Copy of Roadrunner Card, Acceptance Letter or written letter explaining intent to apply $25 registration fee (cash only)

Name: __________________________ DS ID#_________________ Major: __________________________ G.P.A. _________________ Classification for fall: _______________ D.O.B._________________ Home Phone: _____________________ Cell ___________________ Address: __________________________________________ __________________________________________________________ Parents names: ___________________________________________ Parents address: ____________________________________________ ___________________________________________________________ Parents phone: ______________________________________________

E-mail: ____________________________________________________ Shirt size: Shorts size: S S M M L L XL XL

Shoe size: _____________ Height: _____________ Weight: _____________ How did you hear about Cheerleading Tryouts? (Please choose one) Friend Website DS student High School Clinic Facebook

Other__________________ HAVE YOU APPLIED TO DALTON STATE? HAVE YOU BEEN ACCEPTED TO DALTON STATE? SCHOOL CURRENTLY ATTENDING?

LIST PAST CHEER EXPERIENCE: HIGH SCHOOL: __________________________________________________________ COLLEGE: __________________________________________________________ ALL STAR: __________________________________________________________ TUMBLING SKILLS/EXPERIENCE: Standing: Running: STUNT: Position: Stunting Skills:

WE WANT TO GET TO KNOW YOU WHAT MOTIVATED YOU TO TRY-OUT FOR DSC CHEERLEADING?

HOW DO YOU SPEND YOUR LEISURE TIME?

LIST CLUBS/ACTIVITIES IN WHICH YOU PARTICIPATE:

PERSONAL SKILLS THAT MAY CONTRIBUTE YOUR SUCCESS AS A CHEERLEADER:

WHAT ARE YOUR CAREER OBJECTIVES?

THIS IS THE FOUNDING YEAR OF CHEERLEADING AT DALTON STATE. WHAT DO YOU BELIEVE TO BE THE MOST IMPORTANT TRADITION THAT SHOULD BE ESTABLISHED IN CHEERLEADING THIS FIRST YEAR?

Dalton State Cheerleading Statement of UnderstandingI hereby certify that I fully understand the following: 1. Cheerleading involves a variety of gymnastics, motions, partner stunts, rotations and heights; therefore, participation in cheerleading involves some amount of danger of personal injury. I totally assume the risks involved by participating in this cheerleading clinic. I further realize that improper conduct of cheerleading activity could result in catastrophic injury, paralysis or even death. 2. I hereby certify that I have read, am thoroughly familiar with, and will carefully abide by the American Association for Cheerleading Coaches and Advisors (AACCA) guidelines for safety in college cheerleading (THIS WILL BE POSTED IN THE FACILITY WHERE CLINIC IS HELD). 3. I further agree to hold harmless Dalton State College and the coaches, athletics, officers, directors, staff, cheerleading officials and Guild Gymnastics for any injury which I may incur by being a participant in the cheerleading clinic. Medical Insurance Company and Policy Number: ____________________________________ ____________________________________ STATEMENT: I have read carefully this memorandum, and I understand and accept the information and requirements contained in it. Signature _________________________ Date ____________________ If under the age of eighteen years old a parent or guardians signature is required. Signature _________________________ Date______________________