2018-2019 choctawhatchee hs sideline cheerleading tryouts · 2018-2019 choctawhatchee hs sideline...

2018-2019 Choctawhatchee HS Sideline Cheerleading Tryouts Candidates should turn in the following to Choctaw’s front office by Monday, May 7th, 2018:

1. Application with a current picture (White)2. Tryout Permission Form – Notarized (Pink)3. Demerit Contract (Yellow)4. Grades Contract (Green)

5. His/her current physical (EL2) (White)6. Consent and Release From Liability Certificate (EL3) (Purple)7. Emergency Medical Authorization Form (MIS5358) – Must Be Notarized (Blue)8. Consent for Impact testing (MIS5348) (Orange)

9. Insurance information (must have have insurance or purchase school insurance )10. Copy of Birth Certificate (must have on file in the school office)11. $30 clinic fee (includes judges’ fees). Make checks payable to: Choctaw Cheerleaders.

**The remainder of the packet should stay with you for future reference. Late applications will have a ten-point deduction per day from the judges’ final score. No applications will be accepted after Wednesday, May 9, 2018.

Choctawhatchee High School will be doing student athlete physicals for all incoming freshman and current Choctaw students. Check with the front office for more information. Students MUST have a current physical to tryout.

*****IMPORTANT: NEW THIS YEAR – EACH CANDIDATE MUST HAVE A CURRENT EMAIL ON THEIR APPLICATION. THIS IS HOW YOU WILL RECEIVE THE LINK FOR THE TRYOUT MATERIAL! IT IS MANDATORY THAT ALL CANDIDATES LEARN THE MATERIAL BEFORE CLINIC BEGINS ON FRIDAY EVENING!! (Videos of material may be available upon request!)*****

OPEN WORKOUTS (ALL PAPERWORK MUST BE COMPLETED IN ORDER TO ATTEND): Tuesday, April 24th : 3:00PM-5:00PM (Location TBA - Follow us on social media for notification of location) Tuesday, May 1st : 3:00PM-5:00PM (Location TBA - Follow us on social media for notification of location)

MANDATORY CHEERLEADING TRYOUT CLINIC: Friday, May 11th : 6:30PM – 9:00PM (Check-in starts at 5:30 PM @ Choctaw HS Gym) Jumps/Tumbling/Review All Material (Cheer/Chants/Band Dance)/Stunts AND Saturday, May 12th : 9:00AM – 12:00PM (@ Choctaw HS Gym) Review All Materials/Mock Tryout/Stunts

MANDATORY TRYOUTS: Saturday, May 12th at 3:00PM (@ Choctaw HS Gym)

***Tryout Clinic and Tryouts are closed to spectators. The decisions of the judges will be considered final.***

ATTIRE: Participants should wear any combination of green, black and white shorts, sports bras and/or t-shirts (girls need a form-fitted shirt if wearing a t-shirt), and cheerleading shoes to all Clinics. For tryouts, girls: please wear black shorts with a black sports bra and/or form-fitted shirt with a green, black, or white bow. Hair must be pulled back away from the face. Jewelry of any kind is not permitted. Guys please wear: black shorts with a solid white t-shirt.

JUDGING: (maximum 200 points total) Candidates will be judged during tryouts on their performance in the following categories:

● SKILLS: (up to 150 points total)○ Gymnastics (40 points – 20 points Standing/20 points Running)

■ PLEASE DO NOT THROW A SKILL FOR THE FIRST TIME AT TRYOUTS!!○ Chants – 2 Sideline Chants in Lineup/Stunts (30 points – 15 points each)○ Cheer – UCA Style with skills (40 points)

○ Jumps (20 points)○ Dance – Females only (20 points)

○ Partner Stunts – Males only (20 points) ● GRADES: (up to 25 points)

○ Candidates must meet the academic eligibility requirements specified by the Florida DOE and the Okaloosa County School Board affecting interscholastic athletic participation. Candidates must have a cumulative 2.0 GPA.

● DISCIPLINE RECORD: (up to 25 points) SQUAD SELECTION: At the time of tryouts, cheerleaders will be announced as ONE team consisting of approximately 30 members (this number may not be exact). Varsity and JV teams will not be determined until after summer conditioning. This gives us the entire summer to evaluate skills. In order to be on the Varsity Sideline team, all members must have a standing tuck. When naming squads, skill level and performance throughout the summer will determine team placements. Once these teams are named, they will not change during the season. When named, each team will consist of the following:

● Varsity (9th – 12th) – a total of 20 members (including males if applicable) will be selected based on highest scores and skill level. The female minimum requirement for the Varsity Sideline team is a standing tuck and the male minimum requirement for the Varsity Sideline team is a toss extension with assigned top girl(s).

● Junior Varsity (9th – 12th) – a total of 8+ members (including males if applicable) will be selected. TEAMS FOR GAMES:

● Varsity Football Games – Varsity Sideline Cheerleaders will cheer all Varsity Football games. Behavior/skills will be monitored on a weekly basis. If a cheerleader is not performing at the expected level, they may not cheer on the sideline from week to week.

● JV Football Games – JV Sideline Cheerleaders will cheer all home JV games, away games at FWBHS and Niceville HS, and selected Varsity games (i.e. Homecoming).

● Ninth Grade Football Games – the ninth grade cheerleaders will cheer all home ninth grade football games and away games at FWBHS and Niceville HS. They will also cheer either Varsity or JV Football games (depending on which squad they make.)

● Boys and Girls Basketball Games – Basketball games will be split between the Varsity/JV Sideline Only members and the Competition Team members.

● Football/Basketball Playoff Games – Sideline cheerleaders are required to attend ALL football playoff games and assigned basketball playoff games.

LEADERSHIP POSITIONS: Leaders for each team will be named when coaches feel appropriate. The following will be considered when naming leaders:

● Team Survey ● Keeps a positive attitude in all situations and has the ability to pull others out of the cycle of spreading

negativity and complaints ● Shows respect to all members of the program and is the Coaches’ advocate ● Sets an example at all times in and out of cheer

○ Does not have excuses, does not slack off, etc. ● Has proven Choctaw Cheer is a priority

○ Does not show up late, attends practice regularly with little to no misses, shows up prepared for practice (attire, attitude, promptness, etc.)

● Upholds school standards/rules and maintains satisfactory grades PEP RALLIES:

● Members who are absent from practice on the days that pep rallies are worked on may be removed from sections of the routine or the entire pep rally itself.

UNFORESEEN EVENTS (Football/Playoffs, Community Appearances, etc.): For each event that may arise, a minimum number of cheerleaders will be set. We will first ask for volunteers and if the minimum number of cheerleaders has not been reached, cheerleaders will be assigned to these events.

● The order in which members will be assigned will be based on those who have not volunteered for a previous event being at the top of the list.

PRACTICE/MEETINGS: Parent Meeting:

● There will be a mandatory Sideline Cheerleader/Parent meeting on Monday, May 14th at 6:00 PM in the Media Center. Cheerleaders and at least one parent must be in attendance! The first installment of $300 is due at this meeting (this payment will cover a portion of camp and campwear).

Summer Cheerleading Camps: ● It will be mandatory for all Sideline Cheerleaders to attend the UCA Elite Camp at Florida State University

in Tallahassee, FL on June 22nd – June 25th. Summer Practices for Sideline Cheerleaders:

● Summer practice will be held Monday, June 4th – Thursday, August 2nd. Practices will be Monday - Thursday from 7AM – 10AM and Friday from 8 AM – 10 AM. (Fridays will be added if needed AT ANY TIME)

● Fridays from 8AM-9AM during the summer will be considered “Demerit Days”. This is MANDATORY for each cheerleader that has demerits. If a cheerleader fails to show up, this will count as a missed practice.

● There will be NO cheerleading practice from Tuesday, June 26th – Friday, July 13th. Please plan ALL vacations during this time period when there are no practices. Cheerleaders will NOT be excused from practice for vacations during camp or practice times.

● Summer practices will resume Monday, July 16th and the schedule will follow the normal practice times Monday, July 16th – Friday, August 3rd.

● Chant Checks (including band dances): ○ Monday, July 16th – New cheerleaders will receive a link to a video of all sideline chants/band

dances the first week of summer practice and are expected to learn them before the first chant check on Monday, July 16th. This chant check will be for ALL cheerleaders, new and returning. IT IS YOUR RESPONSIBILITY TO KNOW THESE CHANTS - IF YOU NEED EXTRA PRACTICE, IT IS ON YOU TO GET EXTRA PRACTICE WITH A RETURNER!!!

○ Monday, July 30th – Last chant check before football season! We will check all cheerleaders again on this date and any cheerleader who does not know the sideline chants will sit from the first football game. During this week, we will name the Varsity and JV Sideline Teams.

School Year Sideline Practice: During Football Season:

● Cheerleading practices will be held during 7th period and after school until 4:00pm Monday – Wednesday and during 7th period on Friday. Gym will be Thursdays from 1:30-3PM.

○ Please understand that missing practice not only punishes that individual but also the entire team. Stunt groups will be assigned at the beginning of the year and will not change for pep rallies/games unless necessary. As a result, if a group member misses practice, the ENTIRE stunt group will sit out of the specific stunt. Groups will not be rearranged due to missing team members!

During Basketball Season:

● Cheerleading practices will be held during 7th period and after school until 3:00pm Monday – Thursday and during 7th period on Friday. This will be the schedule for the remainder of first semester. Gym will remain on Thursdays from 1:30PM – 3:00PM.

○ Exact dates of change in practice time will be sent out once playoffs for football are done. ● Once Basketball chants have been covered and routines have been made up for games, practice will only

be 7th period (once first semester is over). If needed, after school practices may be called the first two weeks of second semester.

● At the end of the first semester, cheerleaders who are sideline only (those not on the competition team) will have the option to transfer out of 7th period cheer class second semester.

○ The team members who opt to stay in cheer class 7th period should understand that the class period turns into a conditioning class (this is how they will receive their weekly grades for the remainder of the school year). This means they are expected to participate in any activity assigned for the day i.e. conditioning, stunting, jumps, tumbling, etc.

○ Please remember that 7th period is a CLASS, just like the other six periods. Points will be taken off for absences and refusal to participate. If they are not there to participate, they cannot earn the points.

● The coach or captain may call additional practices or extend practice times if needed (advanced notice will be given so that transportation can be arranged).

● The coach MUST be notified BEFORE practice if you will be out. Sending word with another cheerleader or not calling is NOT acceptable. Double Conditioning will be assessed if a cheerleader is a NO SHOW.

Gymnastics:

● Cheerleaders will be required to attend a MANDATORY gymnastics class throughout the year one day a week as well as keep up with the monthly payments. Payments will be arranged through the gym. The cost of gymnastics will be approximately $60 per month. Summer gymnastics will start the week of June 4th and run through August 2nd. Gymnastics throughout the school year will begin the week of August 13th and run through May 16th.

IMPORTANT/MANDATORY ATTENDANCE DATES FOR ALL SIDELINE CHEERLEADERS: ● June 22nd – June 25th: UCA Elite Camp @ Florida State University (Tallahassee) ● ALL cheerleading practices, football games, assigned basketball games, and ALL fundraisers

FUNDRAISING: Our program provides many fundraising opportunities to help with expenses. Each cheerleader (and/or parent) will be required to participate in ALL fundraisers.

Major fundraisers will include: (Estimated Total Revenue Per Cheerleader = $1500) ● Golf Tournaments) – (June 8) Each cheerleader will secure one 4-man team, 3 hole sponsors, and 3 door

prizes. This will tentatively be held in October. ● Football Poster Ad Sales – (May - June 2018) Each cheerleader will sell a minimum of 3 poster ads @

$100 each to local businesses or individuals. ● “Baggings” – (Dates TBD – Saturdays/Sundays) All cheerleaders (and parents) will sign-up for shifts for

each bagging. ● Cheerleading Youth Clinic(s) – (September/October) Cheerleaders will be present to teach material. ● Turkey Trot Run – (November) Each cheerleader (and 1 parent) are expected to participate the day of the

race, donate 1 case of water, and secure 10 runners. ● Bowling Tournament – (December) Each cheerleader will secure one team, 1 lane sponsors, and 3 door

prizes. This will tentatively be held in December. ● Sponsorships – (May – January) Each cheerleader will secure a minimum of 5 Sponsorships at $100 each.

● Miscellaneous Fundraisers include but are not limited to – Spirit Cup Sales, Fan Cloth Sales, Cookie Dough Sales, and Flamingos.

● Restaurant “Spirit Nights” – Chipotle, Panera Bread, Sonny’s, Panda Express, Buffalo Wild Wings, etc. EXPENSES: Camp and Practice Uniform Expenses: Each cheerleader is required to pay for their practice uniforms and camp at the beginning of the year. Practice uniforms will not be handed out until the cheerleader has paid for them and cheerleader will not attend camp unless camp expense is paid. Some expenses can be defrayed by fundraising but not the first two payments due May 14th and June 15th. Payments will be broken down as follows: Date Expense Amount Due May 15th Camp (ALL) – Varsity Deposit Fees $300 June 15th Practice Wear (ALL GIRLS) $300 June 15th Practice Wear (BOYS) $150 July 12th Camp (ALL) – Bus, Varsity Balance, Hotel $285 August 1st Practice Wear Balance/Shoes (ALL) $200

● New Female Cheerleaders: will be required to pay an additional $65 for Poms in August and $230 for Warm-ups in September.

● New Male Cheerleaders: will be required to pay an additional $40 for Megaphones in August and will have the option to purchase Warm-ups for $230. Payable in September.

● Additional practice wear expenses will include spirit tees, leggings, extra briefs, etc. and will be payable in August/Sept.

Due to the cheerleading programs current account balance, ALL accounts must be up-to-date with payments in order to participate in upcoming events (Camps, Major Pep Rallies, Major Games, etc); this includes all outstanding balances from previous years. (Exceptions may be made for those cheerleaders who make payment arrangements at the start of the season.) *If a cheerleader chooses to quit or is dismissed from the team for any reason, they are still responsible for ALL applicable financial fees.* DEMERITS:

● Opportunities to Improve (OTI’s) will be introduced this year in order to keep the list of demerits from building up each semester.

● Demerits, such as BLOCKS, will still being given for offenses such as No Shows to practices or games, unexcused absences from practices or games, loss of skills, etc.

● Refer to the Demerit Contract for clarification as to which offenses will be given OTI’s and which ones will result in the normal demerits (BLOCKS).

Demerits MUST be worked off in order to participate in upcoming events (Camps, Pep Rallies, Games, etc) in the amount of time specified by the coach.

CHEERLEADER RESPONSIBILITIES: ● Cheerleaders are selected to represent all sports designated by the coach and/or school administration.

● Cheerleaders are expected to be leaders, not followers.

● Cheerleaders are to be exemplary citizens and school representatives.

● Cheerleaders are to accept all responsibilities assigned by the coach, captain or school official without complaint.

● Cheerleaders are expected to be pleasant, respectful, courteous, and considerate of the members of their own squad, their captains, and their coaches.

● Cheerleaders are expected to work daily during the season to improve their skills and be an asset to the team.

● Cheerleaders must be present during a minimum of 4 class periods to be able to participate in any function that day.

● Cheerleaders are expected to participate in all practices, games and performances. If an absence is necessary, it must be approved by the coach BEFORE the absence occurs. Not all absences that are approved will be considered excused. Any unexcused absence may result in a suspension from an upcoming performance, pep rally and/or game.

● Cheerleaders are expected to participate in unforeseen appearances (playoffs, community events, etc.).

● Cheerleading is always the FIRST priority. If a cheerleader chooses to participate in another sport, another competitive cheer team, or maintain a job, cheerleading will remain first priority. Schedules of appearances and practices will be published in advance so that work schedules may be arranged accordingly.

● Cheerleading is a one-year commitment. If a cheerleader is removed from the squad, or quits the squad at any time (for reasons other than medical), he/she will receive an “F” as their semester grade and will not be allowed to tryout the following year.

● All fundraising is MANDATORY for all members of the cheerleading squad. If a cheerleader chooses not to participate, he/she must personally pay the amount of profit that fundraiser generated per cheerleader.

● Cheerleaders who receive STP may also face reprimand from their coaches including (but not limited to) extra conditioning, demerits, suspension, etc.

● Cheerleader suspension from school for ANY offense may result in dismissal from the team.

CODE OF CONDUCT STUDENTS

1. I will treat my teammates and coaches with dignity and respect (not arguing, talking-back) and do what is asked of me.

2. I understand there is no “I” in “Team.” We must all work together to be successful. 3. I will support and encourage my teammates as they learn new skills. 4. I will put the needs of the team before my own needs. 5. I will refrain from saying anything to or about someone that may hurt their feelings. 6. I will not make negative comments in person or via phone, text, online post or blog about or directed to

my fellow squad members, my team, our fans or an opposing team. 7. I will work daily during the season to improve my skills and to be an asset to my team. 8. I will leave my negative attitude at home when coming to practice, games, and competitions. 9. I understand that I am responsible for my own actions and attitudes. 10. I will arrive at practices, games, and competitions on time, ready to go, and with a good attitude. 11. I understand that my participation is a season-long commitment to myself, my team, my coach, and my

school. 12. I will conduct myself in such a manner as to bring respect to my school and understand that my behavior

is a reflection upon my team, my coach, my school, my family, and myself. 13. I will organize my time so that my academic responsibilities do not conflict with practices, games, or

competitions. I understand that my team commitment does not excuse me from maintaining academic excellence.

14. I am aware that smoking, drinking, and the use of narcotics and other illegal, chemical substances are harmful to my body and are serious violations of the Okaloosa County Standards of Student Conduct and can result in my dismissal.

15. I will be personally responsible for all school athletic uniforms checked out to me and will return them in good condition or I will pay for their replacement.

16. I understand that any unsportsmanlike conduct or other violation of the Code or the rules determined by the coach my result in disciplinary action.

17. I understand that the coaches have the sole responsibility to decide who cheers which games. PARENTS

1. I will teach my child to compete with the heart of a champion and to work hard to be the best he/she can be.

2. I will demand that my child treat other players, coaches, official, and spectators with dignity and respect regardless of race, creed, sex, or ability.

3. I will promote the emotional and physical well-being of the student athletes ahead of any personal desire I may have for my child.

4. I will not encourage any behaviors or practices that could endanger the health or well-being of the student athletes.

5. I will be a positive role model for my child and encourage sportsmanship by showing respect and courtesy, and by demonstrating positive support for all players, coaches, officials, and spectators at every practice, competition, or sporting event.

6. I will not engage in any kind of unsportsmanlike conduct with any official, coach, player, or parent. 7. I will respect the coaches, their authority, and the decisions they make on behalf of the team. 8. I understand that the coaches have the sole responsibility to decide who cheers which pep rallies and

games; and who is on the competition floor. 9. I will not confront coaches during practice or at athletic venues but will take time to I speak to coaches in

private at an agreed upon time and place. 10. I will inform the coaches of any physical injury that may affect the safety of my child or the safety of

others. 11. I will teach my child to play by the rules and to resolve conflicts without resorting to hostility or violence. 12. I will teach my child to be responsible and informed (i.e. looking at cheer calendar, listening when coaches

give directions, etc.)

HEALTH/INSURANCE: ● Each cheerleader must have a complete physical examination by a physician.

● Each cheerleader must have proof of insurance on file with the school.

● Each cheerleader must have an emergency medical release form on file with the school.

● Parents assume the responsibility for their son/daughter’s health, medical, and accidental insurance for both tryouts and for the cheer season.

UNIFORMS: Uniforms are school property. Alterations and upkeep are the responsibility of the cheerleaders. If uniforms need to be altered, they are NOT to be cut in any way. Uniforms must be returned to the school. The practice uniforms are the cheerleaders to keep. A fee of at least $50 per uniform piece will be assessed if uniforms are not returned or up to $50 per uniform piece if returned in poor condition.

COMPETITION CHEERLEADING INFORMATION: Anyone interested in being a part of the Competition team needs to participate in the following:

● IMPORTANT ATTENDANCE DATES: ○ Monday, May 14th: UCA sizing appointment @ 1:30pm

○ Monday, May 14th: Cheerleaders/Parent Meeting @ 6:00pm – Payment due of $300 (females)

and $150 (males) for campwear. ○ Summer Conditioning: Monday, June 4th – Thursday, June 21st - Practices will be from 7AM –

1030AM on Monday - Thursday. ○ October 5th: Competition Team Tryouts (2pm)

○ ALL Fundraisers

● IMPORTANT COMPETITION DATES: ○ December or January: UCA Regionals – (Date and Location TBA)

○ January 2019: FHSAA Regionals (Date and Location TBA)

○ February 2019: FHSAA State Cheerleading Competition (Date and Location TBA)

○ February 8th – 10th, 2019: UCA National High School Cheerleading Championship – Orlando, FL

○ Two addition local competitions (Dates and Locations TBA)

COMPETITION FEES: (approximately $2200) will be charged beginning in October and will include choreography, travel and participation in FHSAA Regionals and State Competitions, UCA Regionals, and UCA Nationals. Fundraising will be available to help with expenses. Competition cheerleaders/parents are encouraged to participate in ALL cheerleading fundraisers throughout the year to offset expenses.

**IMPORTANT: There is a risk of injury involved with cheerleading and practices. Parents must understand the risk of injuries and have the appropriate emergency medical forms completed and notarized.** ____________________________________________ Macey Buchanan, Head Sideline/Competition Coach

Choctawhatchee High School Sideline Cheerleading

2018-2019 Application

Name: __________________________________

Phone Number: ___________________________

Email: ___________________________________

Emergency Contact Info (Name/Number/Email):

_________________________________________

Age: ______ Upcoming Grade: ________

Date of Birth: _____________ Current GPA: _____

Squad(s) Interested In (Check all that apply):

______Sideline ______Competition

Prior cheer Experience:

______________________________________________________________________________

______________________________________________________________________________

Tumbling Skills:

______________________________________________________________________________

Position(s) Interested In (Check all that apply):

______Flyer

______Main Base

______Side Base (Secondary)

______Back Spot

What stunts have you performed? _________________________________________________

______________________________________________________________________________

What does being a Choctaw Cheerleader mean to you? ________________________________

______________________________________________________________________________

What do you have to offer the team?_______________________________________________

______________________________________________________________________________

Who is your role model and why? _________________________________________________

_____________________________________________________________________________

Are you currently employed? If yes, how will you manage to not let it interfere with cheer?

______________________________________________________________________________

Do you plan on participating in any other sport? If so, what? ___________________________

Strengths: _____________________________________________________________________

Weaknesses: ___________________________________________________________________

Sizes:

T-Shirt: ______________ Loose Tank Top: ________

Fitted Tank Top: ________ Nike Sport Bra: ________

Nike Spandex: ________ Nike Track Shorts: ________

Shoe Size: ________

I have read the rules and regulations set forth by the Coaches and Principal of

Choctawhatchee High School. I have read, understand, and agree to abide by the

Student/Parent Code of Conduct. I am interested in trying out for Choctaw Cheerleading and

if selected, I agree to abide by the set rules.

______________________________________________

Student Signature Date

______________________________________________

Parent Signature Date

Choctawhatchee High School Cheerleading 2018-2019 Tryout Permission Form

My son/daughter, ______________________________________, has my permission to tryout for

cheerleading at Choctawhatchee High School. I understand that he/she must abide by the rules and

regulations set forth by the Coaches and the principal of Choctawhatchee High School. I understand that

he/she must be present for all the practices and games. My son/daughter and I have read the rules and

regulations in the tryout packet and understand that violation of any of these rules may lead to

probation or temporary/permanent suspension from the squad. I understand that all forms must be

completed and turned in by Monday, May 7th or the packet will be considered late – this will result in a

ten point deduction from his/her total score. No applications will be accepted after Wednesday, May

9th. (Please bring all completed forms to the Front Office of Choctawhatchee High School.)

● I understand that no parents will be allowed inside Choctawhatchee High School during the

entire tryout process (May 11th and May 12th).

● I understand the estimated costs described in the packet and understand that all financial

obligations must be met in a timely manner. Fundraisers will be provided to assist with this

obligation. Failure to meet financial obligations may affect competition travel, tryouts and

graduation.

● I understand that all practices, camps, and games are mandatory (unless specified by the

Coaches) and my son/daughter agrees to be in attendance. Unexcused absences will result in

demerits and/or suspension from upcoming performances and games.

● Summer vacations are to be taken between June 26th and July 13h.

● I understand and give my permission for my son/daughter to ride with the Coaches and/or other

parents when necessary. Cheerleaders are responsible for getting themselves to and from all

activities within the district boundaries (with the exception of Crestview High School).

______________________________________________ Parent or Guardian Signature Date

STATE OF FLORIDA – COUNTY OF OKALOOSA

The foregoing instrument was acknowledged before me this _____________ by ___________________

(Date) (Name of Person Acknowledged)

Who is personally known to me or who has produced _____________________ as identification and

who did or did not take an oath. (Type of Identification)

______________________________________ _____________________________________ Signature of Notary Taking Acknowledgement Name of Notary Typed, Printed, Stamped

Notary Expiration: ____________________________

2018 - 2019 Cheerleading Demerit Contract

The coaches will issue demerits and disciplinary actions. This demerit system has been designed to build a disciplined cheerleading squad with a respectable reputation. Since these guidelines cannot cover all situations, the coach reserves the right to handle special cases. Each situation will be dealt with in a proper manner decided upon by the coach with assistance from the administration. A cheerleader may be dismissed from the squad for repeated and flagrant violations of these rules. Demerits/OTI start the day following cheerleader tryouts and end at the end of the cheer season.

A COACH MUST BE NOTIFIED BEFORE PRACTICE IF YOU WILL BE OUT. SENDING WORD BY ANOTHER CHEERLEADER OR NOT CALLING IS NOT ACCEPTABLE!! The coach MUST be notified before practice if you will be out. Sending word with another cheerleader or not calling is NOT acceptable. Double Conditioning will be assessed if a cheerleader is a NO SHOW.

Issue Repercussion

Wrong/No Bow OTI of the day Wrong Bra OTI of the day

Wrong Shorts OTI of the day Wrong Top OTI of the day

Wrong/No Shoes OTI of the day Wrong Game Day Uniform OTI and will sit out

Missed Practices *unexcused* 1 MISSED: 1 Block 2 MISSED: 2 Blocks 3 MISSED: 2 Blocks and 1 Week of Probation 4 MISSED: 2 Blocks and 2 Weeks of Probation 5 MISSED: Dismissal from the team may be up to the

Coaches’ discretion Missed Game *unexcused* 1 MISSED: 2 Blocks

2 MISSED: 2 Blocks and 1 Week of Probation 3 MISSED: 3 Blocks and 2 Weeks of Probation 4 MISSED: 4 Blocks and 1 Month of Probation 5 MISSED: Dismissal from the team may be up to the

Coaches’ discretion No Show to practice or game.

1 MISSED: 2 Blocks and 1 Week of Probation 2 MISSED: 2 Blocks and 2 Weeks of Probation 3 MISSED: 3 Blocks and 1 month of Probation 4 MISSED: Dismissal from the team may be up to the

Coaches’ discretion Attitude/Being Disrespectful 1st WARNING: 1 Block

2nd WARNING: 2 Blocks and Parent Contact 3rd WARNING: 2 Blocks, 1 Week of Probation and Parent Contact 4th WARNING: Dismissal from the team may be up to the Coaches’ discretion

Detention/STP Detention (repercussions may vary due to offense):

1st OFFENSE: 1 BLOCK PER DAY

2nd OFFENSE: 1 BLOCK PER DAY and Probation

3rd OFFENSE: May result in dismissal from the team STP (repercussions may vary due to offense): May result in suspension or dismissal from the team (up

to the coaches discretion)

*Misbehavior leading to Detention or STP will not be

tolerated. You are a leader of this school!*

BLOCK = 1 mile, 1 big stadium, 10 tucks/handsprings, 25 lunges, 100 sit-ups, 50 squats, 25 pushups OTIs may include, but are not limited to: burpees, pushups, stadiums, planks, squats, etc.

** Probations means the cheerleader will sit out of upcoming events (camps/pep rallies/games), but will be in attendance to those events IN UNIFORM. * Attitude/Disrespect to a team member or coach - Each offense will be dealt with directly. Cheerleaders will receive two warnings then put on probation. If attitude still does not improve, cheerleader will be removed from the squad. * Captains and coaches will be responsible for inspection of uniforms, hair, and shoes before any performance * Jewelry of any kind and gum is not and will never be permitted (FHSAA Regulation) * ALL summer workouts MUST be completed before school! * *ALL demerits must be completed by the end of the NINE WEEKS in which they were received!

If 2 “D”s are earned at Mid-Term/Nine Weeks grading period the cheerleader will be required to sit out from the 1st half of games until the grade has been pulled up for 2 consecutive weeks. At that point, the grade must remain higher than a D, or the cheerleader will remain on probation. A weekly grade check will be done for all cheerleaders on probation. If a cheerleader receives an “F” for a Mid-Term/Nine Weeks grading period the cheerleader will be required to sit out from games until the next Nine Weeks grades/Mid-Term grades are released.

“Throw it Thursday”: You will be required to throw your tumbling skills that you threw at tryouts until a NEW skill is acquired. If you do not throw your minimum skills (skills thrown at tryouts), or skills you have mastered since, you will be on probation for a week. Probation includes sitting in uniform at any cheer events or activities; games, pep rallies, etc. OR cheering extra games and receiving blocks - (In the event of injury/illness WITH a Dr.’s note, exceptions MAY be made).

Please initial and sign that you understand the information in this contract: ___ I understand that all practices (Summer, Fall and Spring) are MANDATORY. If I miss practice for any reason, I understand I will face the

repercussions listed above. (Cheerleaders will only be excused from practice if there is a death in the family, etc – Family vacations are NOT

excused) ___ I understand that a coach must be notified BEFORE practice if you will be out. Sending word by another cheerleader or not calling is NOT

acceptable.

___ I understand that a doctor’s notes must be provided in order for a cheerleader to be excused from physical activities at practices or games.

Doctor’s notes must specify what activities a cheerleader cannot participate in. Cheerleaders must still attend practice when injured or sick.

___ I understand that if I do not maintain my skills from week to week I could face probation until I get those skills back.

___ I understand that based on my grades at the end of each Nine Weeks, I will face repercussions if I have a D or an F.

___________________________ ___________________________ Parent Signature Student Signature

Choctaw Cheerleading Grading System Grading Requirements

1. All team members must maintain a minimum G.P.A. of 2.0 per nine weeks; Leaders must maintain a G.P.A. of 2.5.

2. If 2 “D”s are earned at Mid-Term/Nine Weeks grading period the cheerleader will be required to sit out from the 1st half of games until the grade has been pulled up for 2 consecutive weeks and any pep rally that occurs within that time period. At that point, the grade must remain higher than a D, or the cheerleader will remain on probation. A weekly grade check will be done for all cheerleaders on probation.

3. If a cheerleader receives an “F” for a Mid-Term/Nine Weeks grading period the cheerleader will be required to sit out from games until the next Nine Weeks grades/Mid-Term grades are released and any pep rallies that may occur within that time period.

4. All team members must pass five classes or suspension will result. 5. More than one “2” in conduct per grading period will be the basis for conditioning. 6. Poor conduct grades in repeat classes, or after school detention will be the basis for a two week

probation. 7. Class grades are based upon attendance and participation. 8. Quitting the Sideline Team at any point in the year will result in an automatic “F” for the class and you will

be prohibited from trying out for the Sideline Team for a year (1 full season). 9. “Cheerleading class” is held Monday-Friday.

How Grades are Determined (100pts per week – 20pts possible per day) 60% - Dressing out (correct uniform) (10pts per day) 20% - Class Participation (attitude)/Conditioning (Daily running & conditioning) (5pts per day) 20% - Skills (knowledge and execution of the required skills) (5pts per day)

Points will be lost for the following reasons: - Unexcused Missed Practice (20 points per day) (coach decides excused or unexcused - this does not

mirror excused or unexcused absences from school) - Not Dressed (10 points per day) - Wrong practice outfit (5 points per day) - Attitude with the Coach or other cheerleaders (5 points per situation) - Lost skills (2 points per day)

Practices 1. A practice schedule has been given, and we will try not to veer from the schedule. However, it is

impossible to predict an entire school year worth of practices. If at any point we feel that more rehearsal time is needed, we will give you advanced notice.

2. Regarding performance and school functions, the information is given as quickly as we receive it. Often times, direction comes from Student Activities or from Administration. At times, things do change at the last minute. Again, we will get this information as quickly as we receive it.

3. ALL TEAM MEMBERS ARE REQUIRED TO BE AT ALL “TEAM EVENTS,” THIS INCLUDES CLASS TIME, PRACTICES, PERFORMANCES, TRIPS, ETC.

4. Please do not schedule your appointments during Cheerleading class or practice time. These will be unexcused absences.

5. If you are injured or sick, you are still expected to be in practice. Attending practice to at least watch or “mark through” routines will help you more than missing an entire day.

6. Excused practices will only be given in extreme cases - all other missed practices are UNEXCUSED and will result in conditioning and loss of points for that day.

7. Each team member is responsible for knowing the material for all games and pep rallies. The Coaches have the right to hold any cheerleader out of a routine/game/performance, if they do not know the material presented. This is never our intention, however at times it is necessary.

Parent Signature ________________________________________________________________ Cheerleader Signature ___________________________________________________________

Florida High School Athletic Association

Consent and Release from Liability Certificate (Page 1 of 4)This completed form must be kept on file by the school. This form is valid for 365 calendar days from the date of the most recent signature.This form is non-transferable; a change of schools during the validity period of this form will require this form to be re-submitted.

EL3Revised 03/18

Part 1. Student Acknowledgement and Release (to be signed by student at the bottom)I have read the (condensed) FHSAA Eligibility Rules printed on Page 4 of this “Consent and Release Certificate” and know of no reason why I am not eligible to represent my school in interscholastic athletic competition. If accepted as a representative, I agree to follow the rules of my school and FHSAA and to abide by their decisions. I know that athletic participation is a privilege. I know of the risks involved in athletic participation, understand that serious injury, including the potential for a concus-sion, and even death, is possible in such participation, and choose to accept such risks. I voluntarily accept any and all responsibility for my own safety and welfare while participating in athletics, with full understanding of the risks involved. Should I be 18 years of age or older, or should I be emancipated from my parent(s)/guardian(s), I hereby release and hold harmless my school, the schools against which it competes, the school district, the contest officials and FHSAA of any and all responsibility and liability for any injury or claim resulting from such athletic participation and agree to take no legal action against FHSAA because of any accident or mishap involving my athletic participation. I hereby authorize the use or disclosure of my individually identifiable health information should treatment for illness or injury become necessary. I hereby grant to FHSAA the right to review all records relevant to my athletic eligibility including, but not limited to, my records relating to enrollment and attendance, academic standing, age, discipline, finances, residence and physical fitness. I hereby grant the released parties the right to photograph and/or videotape me and further to use my name, face, likeness, voice and appearance in connection with exhibitions, publicity, advertising, promotional and commercial materials without reservation or limitation. The released parties, however, are under no obligation to exercise said rights herein. I understand that the authorizations and rights granted herein are voluntary and that I may revoke any or all of them at any time by submitting said revocation in writing to my school. By doing so, however, I understand that I will no longer be eligible for participation in interscholastic athletics.

Part 2. Parental/Guardian Consent, Acknowledgement and Release (to be completed and signed by a parent(s)/guardian(s) at the bot-tom; where divorced or separated, parent/guardian with legal custody must sign.) A. I hereby give consent for my child/ward to participate in any FHSAA recognized or sanctioned sport EXCEPT for the following sport(s):

__________________________________________________________________________________________________________________________________List sport(s) exceptions here

B. I understand that participation may necessitate an early dismissal from classes. C. I know of, and acknowledge that my child/ward knows of, the risks involved in interscholastic athletic participation, understand that serious injury, and even death, is possible in such participation and choose to accept any and all responsibility for his/her safety and welfare while participating in athletics. With full understanding of the risks involved, I release and hold harmless my child’s/ward’s school, the schools against which it competes, the school district, the contest officials and FHSAA of any and all responsibility and liability for any injury or claim resulting from such athletic participation and agree to take no legal action against the FHSAA because of any accident or mishap involving the athletic participation of my child/ward. I authorize emergency medical treatment for my child/ward should the need arise for such treatment while my child/ward is under the supervision of the school. I further hereby authorize the use or disclosure of my child’s/ward’s individually identifiable health information should treatment for illness or injury become necessary. I consent to the disclosure to the FHSAA, upon its request, of all records relevant to my child/ward’s athletic eligibility including, but not limited to, records relating to enrollment and attendance, academic standing, age, discipline, finances, residence and physical fitness. I grant the released parties the right to photograph and/or videotape my child/ward and further to use said child’s/ward’s name, face, likeness, voice and appearance in connection with exhibitions, publicity, advertising, promotional and commercial materials without reservation or limitation. The released parties, however, are under no obligation to exercise said rights herein.D. I am aware of the potential danger of concussions and/or head and neck injuries in interscholastic athletics. I also have knowledge about the risk of continuing to participate once such an injury is sustained without proper medical clearance. READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF MY CHILD’S/WARD’S SCHOOL, THE SCHOOLS AGAINST WHICH IT COMPETES, THE SCHOOL DISTRICT, THE CONTEST OFFICIALS AND FHSAA USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERI-OUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM MY CHILD’S/WARD’S SCHOOL, THE SCHOOLS AGAINST WHICH IT COMPETES, THE SCHOOL DISTRICT, THE CONTEST OFFICIALS AND FHSAA IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO RE-FUSE TO SIGN THIS FORM, AND MY CHILD’S/WARD’S SCHOOL, THE SCHOOLS AGAINST WHICH IT COMPETES, THE SCHOOL DISTRICT, THE CONTEST OFFICIALS AND FHSAA HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

E. I agree that in the event we/I pursue litigation seeking injunctive relief or other legal action impacting my child (individually) or my child’s team participa-tion in FHSAA state series contests, such action shall be filed in the Alachua County, Florida, Circuit Court. F. I understand that the authorizations and rights granted herein are voluntary and that I may revoke any or all of them at any time by submitting said revocation in writing to my school. By doing so, however, I understand that my child/ward will no longer be eligible for participation in interscholastic athletics. G. Please check the appropriate box(es):____ My child/ward is covered under our family health insurance plan, which has limits of not less than $25,000.

Company: ____________________________________________________________ Policy Number: ____________________________________ My child/ward is covered by his/her school’s activities medical base insurance plan. ____ I have purchased supplemental football insurance through my child’s/ward’s school.

I HAVE READ THIS CAREFULLY AND KNOW IT CONTAINS A RELEASE (Only one parent/guardian signature is required)

__________________________________________________ ____________________________________________________ _______/_______/____________Name of Parent/Guardian (printed) Signature of Parent/Guardian Date


I HAVE READ THIS CAREFULLY AND KNOW IT CONTAINS A RELEASE (student must sign)

__________________________________________________ ____________________________________________________ _______/_______/____________Name of Student (printed) Signature of Student Date

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School: __________________________________________ School District (if applicable): __________________________

EL3Revised 03/18Florida High School Athletic Association

Consent and Release from Liability Certificate for Concussions (Page 2 of 4)This completed form must be kept on file by the school. This form is valid for 365 calendar days from the date of the most recent signature.

Concussion InformationConcussion is a brain injury. Concussions, as well as all other head injuries, are serious. They can be caused by a bump, a twist of the head, sudden deceleration or acceleration, a blow or jolt to the head, or by a blow to another part of the body with force transmitted to the head. You can’t see a concussion, and more than 90% of all concussions occur without loss of consciousness. Signs and symptoms of concussion may show up right after the injury or can take hours or days to fully appear. All concussions are potentially serious and, if not managed properly, may result in complications including brain damage and, in rare cases, even death. Even a “ding” or a bump on the head can be serious. If your child reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, your child should be immediately removed from play, evaluated by a medical professional and cleared by a medical doctor.

Signs and Symptoms of a Concussion:Concussion symptoms may appear immediately after the injury or can take several days to appear. Studies have shown that it takes on average 10-14 days or longer for symptoms to resolve and, in rare cases or if the athlete has sustained multiple concussions, the symptoms can be prolonged. Signs and symptoms of concussion can include: (not all-inclusive)

• Vacant stare or seeing stars • Lack of awareness of surroundings • Emotions out of proportion to circumstances (inappropriate crying or anger) • Headache or persistent headache, nausea, vomiting • Altered vision • Sensitivity to light or noise • Delayed verbal and motor responses • Disorientation, slurred or incoherent speech• Dizziness, including light-headedness, vertigo(spinning) or loss of equilibrium (being off balance or swimming sensation) • Decreased coordination, reaction time• Confusion and inability to focus attention • Memory loss • Sudden change in academic performance or drop in grades • Irritability, depression, anxiety, sleep disturbances, easy fatigability • In rare cases, loss of consciousness

DANGERS if your child continues to play with a concussion or returns too soon:Athletes with signs and symptoms of concussion should be removed from activity (play or practice) immediately. Continuing to play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to sustaining another concussion. Athletes who sustain a second concussion before the symptoms of the first concussion have resolved and the brain has had a chance to heal are at risk for prolonged concussion symptoms, permanent disability and even death (called “Second Impact Syndrome” where the brain swells uncontrollably). There is also evidence that multiple concussions can lead to long-term symptoms, including early dementia.

Steps to take if you suspect your child has suffered a concussion:Any athlete suspected of suffering a concussion should be removed from the activity immediately. No athlete may return to activity after an apparent head injury orconcussion, regardless of how mild it seems or how quickly symptoms clear, without written medical clearance from an appropriate health-care professional (AHCP).In Florida, an appropriate health-care professional (AHCP) is defined as either a licensed physician (MD, as per Chapter 458, Florida Statutes), a licensed osteopathicphysician (DO, as per Chapter 459, Florida Statutes). Close observation of the athlete should continue for several hours. You should also seek medical care and inform your child’s coach if you think that your child may have a concussion. Remember, it’s better to miss one game than to have your life changed forever. When in doubt, sit them out.

Return to play or practice:Following physician evaluation, the return to activity process requires the athlete to be completely symptom free, after which time they would complete a step-wise protocol under the supervision of a licensed athletic trainer, coach or medical professional and then, receive written medical clearance of an AHCP.

For current and up-to-date information on concussions, visit http://www.cdc.gov/concussioninyouthsports/ or http://www.seeingstarsfoundation.org

Statement of Student Athlete ResponsibilityParents and students should be aware of preliminary evidence that suggests repeat concussions, and even hits that do not cause a symptomatic concussion, may lead to abnormal brain changes which can only be seen on autopsy (known as Chronic Traumatic Encephalopathy (CTE)). There have been case reports suggesting the development of Parkinson’s-like symptoms, Amyotropic Lateral Sclerosis (ALS), severe traumatic brain injury, depression, and long term memory issues that may be related to concussion history. Further research on this topic is needed before any conclusions can be drawn.

I acknowledge the annual requirement for my child/ward to view “Concussion in Sports-What You Need to Know” at www.nfhslearn.com. I accept responsi-bility for reporting all injuries and illnesses to my parents, team doctor, athletic trainer, or coaches associated with my sport including any signs and symptoms of CONCUSSION. I have read and understand the above information on concussion. I will inform the supervising coach, athletic trainer or team physician immediately if I experience any of these symptoms or witness a teammate with these symptoms. Furthermore, I have been advised of the dangers of participa-tion for myself and that of my child/ward.

__________________________________________________ ____________________________________________________ _______/_______/____________Name of Student-Athlete (printed) Signature of Student-Athlete Date

__________________________________________________ ____________________________________________________ _______/_______/____________Name of Parent/Guardian (printed) Signature of Parent/Guardian Date __________________________________________________ ____________________________________________________ _______/_______/____________Name of Parent/Guardian (printed) Signature of Parent/Guardian Date

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School: _________________________________________ School District (if applicable): __________________________

Florida High School Athletic AssociationConsent and Release from Liability Certificate for Sudden Cardiac Arrest and Heat-Related Illness (Page 3 of 4)This completed form must be kept on file by the school. This form is valid for 365 calendar days from the date of the most recent signature.

EL3Revised 03/18

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Sudden Cardiac Arrest InformationSudden cardiac arrest is a leading cause of sports-related death. This policy provides procedures for educational requirements of all paid coaches and recommends added training. Sudden cardiac arrest is a condition in which the heart suddenly and unexpectedly stops beating. If this happens, blood stops flowing to the brain and other vital organs. SCA can cause death if it’s not treated within minutes.

Symptoms of sudden cardiac arrest include, but not limited to: sudden collapse, no pulse, no breathing. Warning signs associated with sudden cardiac arrest include: fainting during exercise or activity, shortness of breath, racing heart rate, dizziness, chest pains, extreme fatigue.

It is strongly recommended all coaches, whether paid or volunteer, are regularly trained in CPR and the use of an AED. Training is encouraged through agencies that provide hands-on training and offer certificates that include an expiration date.

Automatic external defibrillators (AEDs) are required at all FHSAA State Series games, tournaments and meets. The FHSAA also strongly recommends that they be available at all preseason and regular season events as well along with coaches/individuals trained in CPR.

What to do if your student-athlete collapses:1. Call 9112. Send for an AED3. Begin compressions

FHSAA Heat-Related Illnesses Information People suffer heat-related illness when their bodies cannot properly cool themselves by sweating. Sweating is the body’s natural air conditioning, but when a person’s body temperature rises rapidly, sweating just isn’t enough. Heat-related illnesses can be serious and life threatening. Very high body temperatures may damage the brain or other vital organs, and can cause disability and even death. Heat-related illnesses and deaths are preventable.

Heat Stroke is the most serious heat-related illness. It happens when the body’s temperature rises quickly and the body cannot cool down. Heat Stroke can cause perma-nent disability and death.

Heat Exhaustion is a milder type of heat-related illness. It usually develops after a number of days in high temperature weather and not drinking enough fluids.

Heat Cramps usually affect people who sweat a lot during demanding activity. Sweating reduces the body’s salt and moisture and can cause painful cramps, usually in the abdomen, arms, or legs. Heat cramps may also be a symptom of heat exhaustion.

Who’s at Risk? Those at highest risk include the elderly, the very young, people with mental illness and people with chronic diseases. However, even young and healthy individuals can succumb to heat if they participate in demanding physical activities during hot weather. Other conditions that can increase your risk for heat-related illness include obesity, fever, dehydration, poor circulation, sunburn, and prescription drug or alcohol use.

By signing this agreement, the undersigned acknowledges that the information on Sudden Cardiac Arrest and Heat-Related Illness have been read and under-stood. I acknowledge optional educational opportunities in cardiac arrest at www.nfhslearn.org. Please go to www.fhsaa.org/departments/health for further instructions to view the courses. I have been advised of the dangers of participation for myself and that of my child/ward.




School: _________________________________________ School District (if applicable): __________________________

Florida High School Athletic AssociationConsent and Release from Liability Certificate (Page 4 of 4)This completed form must be kept on file by the school. This form is valid for 365 calendar days from the date of the most recent signature.

EL3Revised 03/18

Attention Student and Parent(s)/Guardian(s) Your school is a member of the Florida High School Athletic Association (FHSAA) and follows established rules. To be eligible to represent your school in interscholastic athletics, in an FHSAA recognized sport (i.e. bowling, competitive cheerleading, girls flag football, lacrosse, boys volleyball, water polo and girls weightlifting or sanctioned sport (i.e. baseball, basketball, cross country, tackle football, golf, soccer, fast-pitch softball, swimming & diving, tennis, track & field, girls volleyball, boys weightlifting and wrestling), the student:

1. This form is non-transferable; a separate form must be completed for each different school at which a student participates.

2. Must be regularly enrolled and in regular attendance at your school. If the student is a home education student or attends a charter school or Florida Virtual School - Full time Program or a special/alternative school or certain small non-member private schools, the student must declare in writing his/her intention to participate in athletics to the school at which the student is permitted to participate. Home education students and students attending small non-member private schools must be approved through the use of a separate form prior to any participation. (FHSAA Bylaw 9.2, Policy 16 and Administrative Procedure 1.8)

3. Must attend school within 10 days of the beginning of each semester to be eligible during that semester. (FHSAA Bylaw 9.2)

4. Must maintain at least a cumulative 2.0 grade point average on a 4.0 unweighted scale prior to the semester in which the student wishes to participate. This GPA must include all courses taken since the student entered high school. A sixth, seventh or eighth grade student must have earned at least a 2.0 grade point average on 4.0 unweighted scale the previous semester. (FHSAA Bylaw 9.4)

5. Must not have graduated from any high school or its equivalent. (FHSAA Bylaw 9.4)

6. Must not have enrolled in the ninth grade for the first time more than four school years ago. If the student is a sixth, seventh or eighth grade student, the student must not participate if repeating that grade. (FHSAA Bylaw 9.5)

7. Must have signed permission to participate from the student’s parent(s)/legal guardian(s) on a form (EL3) provided the school. (Bylaw 9.8)

8. Must not turn 19 before September 1st to participate at the high school level; must not turn 16 prior to September 1st to participate at the junior high level; and must not turn 15 prior to September 1st to participate at the middle school level, otherwise the student becomes permanently ineligibile. (FHSAA Bylaw 9.6)

9. Must undergo a pre-participation physical evaluation and be certified as being physically fit for participation in interscholastic athletics (form EL2).

10. Must be an amateur. This means the student must not accept money, gift or donation for participating in a sport, or use a name other than his/her own when participating. (FHSAA Bylaw 9.9)

11. Must not participate in an all-star contest in a sport prior to completing his/her high school eligibility in that sport. (FHSAA Policy 26)

12. Must display good sportsmanship and follow the rules of competition before, during and after every contest in which the student participates. If not, the student may be suspended from participation for a period of time. (FHSAA Bylaw 7.1)

13. Must not provide false information to his/her school or to the FHSAA to gain eligibility. (FHSAA Bylaw 9.1)

14. Youth exchange, other international and immigrant students must be approved by the FHSAA office prior to any participation. Exceptions may apply. See your school’s principal/athletic director. (FHSAA Policy 17)

15. Must refrain from hazing/bullying while a member of an athletic team or while participating in any athletic activities sponsored by or affiliated with a member school.

If the student is declared or ruled ineligible due to one or more of the FHSAA rules and regulations, the student has the right to request that the school file an appeal on behalf of the student. See the principal or athletic director for information regarding this process.

By signing this agreement, the undersigned acknowledges that the information on the Consent and Release from Liability Certificate in regards to the FHSAA’s established rules and eligibility have been read and understood.




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OKALOOSA COUNTY SCHOOL DISTRICT

STUDENT SERVICES/RISK MANAGEMENT

HIGH SCHOOL INTERSCHOLASTIC ATHLETICS PARENTAL PERMISSION, RELEASE

EMERGENCY MEDICAL AUTHORIZATION AND AUTHORIZATIONN TO RELEASE INFORMATION

NOTICE TO THE MINOR CHILD’S NATURAL GUARDIAN

READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR

CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREENING THAT, EVEN

IF OKALOOSA COUNTY SCHOOL DISTRICT, ITS SCHOOL BOARD, ITS EMPLOYEES, AGENTS OR

ASSIGNS USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR

CHILD MAY BE SEROUSLY INJURED OR KILLED BY PARTICPATING IN THIS ACTIVITY

BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CAN NOT BE

AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT

AND YOUR RIGHT TO RECOVER FROM OKALOOSA COUNTY SCHOOL DISTRICT, IT’S SCHOOL

BOARD, ITS EMPLOYEES, AGENTS OR ASSIGNS IN A LAWSUIT FOR ANY PERSONAL INJURY,

INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE

RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO

SIGN THIS FORM, AND OKALOOSA COUNTY SCHOOL DISTRICT, ITS EMPLOYEES, AGENTS OR

ASSIGNS HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN

THIS FORM.

No student will be allowed to practice or participate in any organized interscholastic athletic activity until this document is signed

notarized and returned to the school Athletic Department

Student name___________________________________________________________________________________________________________Grade_______ male / female

Address_______________________________________________________________________________________________________Home phone ______________________________

City___________________________________________________________________________________Zip ____________________Emergency phone________________________ PURPOSE: To provide the consent of parents and/or guardians for students to participate in interscholastic activities of the School District and

provide a hold harmless release of liability, to authorize the provision of emergency medical treatment for that student who may become ill or

injured during such activities and authorizing the release of protected health information.

PLEASE COMPLETE ALL PARTS

PART I – PARENTAL /GUARDIAN PERMISSION, ACKNOWLEDGEMENT AND RELEASE

A. I, _______________________hereby grant permission for ___________________________(the “Student Athlete”) to participate at

_____________________________School during the school year, and I know of, and acknowledge that my child/ward knows of, the risks

involved in interscholastic athletic participation, understand that serious injury, and even death, is possible in such participation and choose to

accept any and all responsibility for his/her safety and welfare while participating in athletics. With full understanding of the risks involved, I

release and hold harmless my child’s/ward’s school, and the Okaloosa County School District, its School Board, its officers, employees, agents or

assigns, of any and all responsibility and liability for any injury or claim resulting from such athletic participation and agree to take no legal action

against the Okaloosa County School District, its School Board, its officers, employees, agents or assigns, because of any accident or mishap

involving the athletic participation of my child/ward.

I understand the Florida High School Athletic Association requires all students participating in interscholastic athletics be covered by a medical

insurance policy providing a minimum of $25,000limit for medical expenses. I hereby certify __________________________________ is covered

by medical insurance providing at least $25,000 for medical expenses. The name of our medical insurance company is

_____________________________________ which will cover this child in the event of an injury. I assume full responsibility and

liability for any and all expenses connected with an injury and/or illness that is not paid by out insurance company or through Military benefits if

this child is entitled to military privileges. I further certify I will notify the principal of the school this child is attending if there is any change in

this insurance coverage, and I will purchase the Student and/or Football insurance offered at the school. (STUDENT AND/OR FOOTBALL

INSURANCE MAY BE PURCHASED AT YOUR SCHOOL)

B. I grant the released parties the right to photograph and /or videotape my child/ward and further to use said child’s/ward’s name, face, l ikeness,

voice and appearance in connection with exhibitions, publicity, advertising, promotional and commercial materials without reservation or

limitation. The released parties, however, are under no obligation to exercise said rights herein.

C. I also hereby grant permission for my child/ward to be transported by private automobile and/or School District authorized transportation

during the school year in which this release is effective to and from all interscholastic sports events.

PG. 1

MIS 5358

rev. 3/8/2015

PART II – EMERGENCY MEDICAL AUTHORIZATION

In the event reasonable attempts me at ______________________________________________________________(phone number) have been

unsuccessful, I give my consent for (1) the administration of any treatment deemed necessary by ________________________(preferred physician)

or _____________________(preferred dentist), or in the event the designated preferred practitioner is not available, by another physician or

dentist and (2) the transfer and admission of the child to ___________________________(preferred hospital) or any hospital reasonably accessible.

This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentist concurring in the necessity

for such surgery are obtained prior to the performance of such surgery. I hereby authorize any treating physicians, including athletic trainers and

team volunteer doctors, to provide information to school officials regarding my child’s medical condition or injuries. Facts concerning the

child’s medical history including allergies, medications being taken, and any physical impairments to which a

physician should be alerted. (list or write “none”)_______________________________________________________________________________

MEDICAL PROVIDERS MAY ACCEPT A PHOTOCOPY OF THIS SIGNED AUTHORIZATION AS IF IT WERE AN ORIGINAL FOR ALL PURPOSES.

PART III – AUTHORIZATION/CONSENT FOR DISCLOSURE OF PROTECTED HEALTH INFORMATION

I hereby authorize the athletic trainers, sports medicine staff and other health care personnel representing ________________________(student)

To release information regarding the Student Athlete’s protected health information and related information regarding injury or illness during the

Student Athlete’s training for and participation in interscholastic sports at _____________________________________________School. This

protected health information may concern the Student Athlete’s medical status, medical conditions, injuries, prognosis, diagnosis, athlete’s

participation status, and related personally identifiable health information. This protected health information may be released to other health care

providers, hospitals and/or medical clinics and laboratories, Student Athlete’s coaches, medical insurance coordinators, the school’s Athletic

Director and Principal, athletic and/or school administrators, chaplains and/or clergy members, and officials of the Florida High School Athletic

Conference. I also authorize the Student Athlete’s coaches and other school staff to release protect4ed health information to the athletic trainer,

sports medicine staff and other health care personnel as identified above and to other health care professionals providing services to the Student

Athlete. As the parent or guardian of the Student Athlete, I hereby confirm that I have signed this authorization/consent for the disclosure of the

Student Athlete’s protected health information voluntarily. I understand that my child’s protected health information is protected by federal

regulations under the Health Information Portability and Accountability Act (HIPAA) of the Family Educational Rights and privacy Act of 1974

(the Buckley Amendment) and may not be disclosed without either parent/legal guardian authorization under HIPAA or consent under the

Buckley Amendment I the parent/legal guardian understand that once protected health information is disclosed per authorization or consent, the

information is subject to re-disclosure and may no longer be protected by HIPAA and/or the Buckley Amendment. I, the parent/legal guardian,

understand that I may revoke this authorization/consent any time by notifying in writing to the school’s Athletic Director, but if I do, it will not

have any effect on the actions the Okaloosa county School officials took in reliance on this authorization/consent prior to receiving the revocation.

I understand that I may see and obtain a copy of all protected health information described on this form, for a reasonable copy fee, if I ask for it. I

further understand that I may request a copy of this form after I sign it. This authorization/consent expires one year from the date it is signed.

I HAVE READ THE ABOVE AND AUTHORIZE THE DISCLOSURE AND RELEASE OF THE STUDENT ATHLETE’S PROTECTED

HEALTH INFORMATION AS STATED.

************************************************************************************************************************

Concussion & Heat Related Illness Information Release Form (EL3CH) must be signed along with this form, PRIOR TO NOTARIZATION, and

the terms and conditions of the EL3CH Form are considered incorporated into this Authorization.

BY SIGNING BELOW I VERIFY THAT I HAVE READ, REVIEWED AND COMPLETED ALL THREE (3) PARTS OF THIS

PERMISSION AND AUTHORIZATION FROM AND KNOW IT CONTAINS A RELEASE.

_____________________ _________________________________________ _________________________________________________

Date Printed Name of Parent or Guardian Signature of Parent or Guardian

STATE OF FLORIDA-COUNTY OF OKALOOSA

The foregoing instrument was acknowledge before me this ______________________ by ______________________________________________

Date Name of Person Acknowledged

Who is personally known to me or who has produced __________________________________ as identification and who did/did not take an oath

Type of Identification

_______________________________________________________ ___________________________________________________________

Signature of Notary Taking Acknowledgement Name of Notary (Typed, Printed or Stamped)

Notary Expiration:___________________________________________

PG. 2

OKALOOSA COUNTY SCHOOL DISTRICT

STUDENT INTERVENTION SERVICES

CONSENT FOR ImPACT NEUROCOGNITIVE TESTING AND RELEASE OF INFORMATION

FOR ATHLETIC PARTICIPATION IN OKALOOSA COUNTY

PLEASE CHECK AND COMPLETE SECTION “A” OR “B” AND SIGN AT THE BOTTOM

___________________________________________________________________________________

_____Section A

I give my permission for (name of child)___________________________________________________

(Date of Birth)___________________to take the ImPACT Neurocognitive baseline concussion test

administered by the Okaloosa School District system through any of its designated employees and/or

approved volunteers. I give permission for my child to provide all the information requested

necessary to complete the test. I understand that my child may need to be tested more than once,

depending on the validity of the testing results.

I also understand that the test results of the ImPACT Neurocognitive test may be released to my

child’s guidance counselor and teachers, including Principals, Athletic Coaches and trainers, and

nurses for the purpose of providing temporary academic and athletic modifications if necessary for

concussion management. I also consent to the release of the ImPACT testing results to any Medical

Physician, who in the treatment of my concussed child, submits a request for release of medical

records complaint to State and Federal guidelines.

I understand that I may revoke this consent forNeurocognitive testing at any time; however, I also

understand that any release which has been made prior to my revocation and which was made in

reliance upon this authorization shall not constitute a breach of my right to confidentiality.

___________________________________________________________________________________

_____Section B

I do not give my permission for (name of child)_____________________________________________

(Date of Birth)___________________ to take the ImPACT Neurocognitive baseline concussion test

administered by the Okaloosa School District system.

___________________________________________________________________________________

Parent(Guardian) Signature__________________________________________ Date_____________

Student Signature__________________________________________________ Date_____________

MIS 5348

3/2015

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