uncg cheerleading

“We discover and develop champions in life.” -The Spartan Way

UNCG CHEERLEADING 2017 SPRING TRYOUTS

INFORMATION PACKET


2017 UNCG CheerleadingSpring Tryouts

Spring tryouts will be held Saturday, April 29th Tryout Fee: $20/person Times and locations are as follows:

Saturday, April 29, 2017Time: 9 am - 3 pmLocation: Fleming Gym - Coleman Building

Please arrive by 8:30 am / All participants that make the team will have a practice on Sunday, April 30 from Noon - 4 pm in Fleming Gym.

Fleming Gym is located on the first floor of the Coleman Building. Participants may park in the Walker Avenue Parking Deck at a rate of $1/hour.

All Tryout Sessions for the UNCG Cheerleading squad are closed, without exception.

Video Tryout Submission

Submission of a tryout video will be accepted. However, situations will be handled on a case-

by-case basis and the coaching staff reserves the right to deny the option of a video tryout at

their discretion.

All questions regarding UNCG Cheerleading tryouts may be directed in writing to the Head Coach, Dee Brennan, [email protected] or

[email protected].


General Tryout Information

All tryout participants must be: Current, full-time UNCG students (enrolled in a minimum of 12 credit hours) College transfers, or incoming freshman with an acceptance letter. All tryout participants must have a minimum of a 2.3 semester GPA at the time of tryouts.

Tryout Attire You must present a “clean cut” image to be selected as a UNCG Cheerleader. Body piercings,

tattoos, extreme hairstyles/color are not acceptable at tryouts or in uniform if selected as ateam member. Remove all piercings and cover all tattoos prior to arrival at tryouts.

Expected attire for tryouts is as follows:

Ladies: bright colored logo-free bra top black shorts Hair bow and game ready make-up Cheer shoes**You should dress in form fitting athletic clothing. Bra tops, fitted tanks/tees are allacceptable.

Gentlemen: White or light colored logo-free t-shirt black colored gym shorts Cheer shoes


CHECKLIST OF REQUIREMENTS: Tryout Registration Fee: $20, check made payable to UNCG Athletics UNCG Cheerleading Tryout Application (Appendix A)

All questions on the application must be completed before the application will be processed. Headshot (both listed below)

Please submit a photo headshot of yourself and submit along with the other required paper-work.—AND—

Photo copy of UNCG Student ID, if you are a current student Proof of full-time enrollment at UNCG

Documentation must be provided via a print-out from UNCGenie that must contain partici-pant’s name and current GPA (Appendix B)

Copy of 2017 Fall Class Schedule (Appendix C) Students are considered full-time only if they are enrolled in a minimum of 12 credit hours Acceptance letter to UNCG, if an incoming freshman or transfer student

Copy of current physical (conducted within the past 6 months) (Appendix D) **(Must be signed by a physician)

Health Insurance Information Form (Appendix E) A copy of the front and back of the participants insurance card must accompany this form

Consent to Disclose Protected Health Information Form (Appendix F) This form will only be kept on file should the participant be selected as a member of the squad This form requires the signature of a parent or legal guardian, regardless of participant’s

age ICA Agreement & Release Form (Indemnity Form) (Appendix G)

Participants must have a parent or legal guardian’s signature This form requires the signature of a parent or legal guardian, regardless of participant’s

age Insurance Information & Injury Release Forms (Appendix H & I)

Appendix H requires the signature of a parent or legal guardian, regardless of partici-

pant’s age. Appendix I only requires a signature of a parent or legal guardian if partici-

pant is less than 18 years of age.

Sickle Cell Screening Results (Appendix J) **Returning members DO NOT have to complete thisrequirement. Prospective new members only! Lab Results AND Appendix J must be submitted before tryouts. No exceptions.

Please give 24 to 48 hours to receive your lab results. Appendix J requires the signature of a parent or legal guardian, regardless of participant’s

age.

By Mail: UNCG Athletics c/o Dacia Ijames 1408 Walker Ave - 101C Coleman BldgGreensboro, NC 27402

By Fax: To: Dacia Ijames Re: UNCG Cheer Tryouts Fax Number: 336.334.4063

By Drop-off: Office 101C - Coleman BuildingAttn: Dacia Ijames

General Tryout Information continued Tryout Paperwork Requirements All tryout participants must submit the following paperwork and $20 tryout fee (checks made payable to UNCG Athletics) no later than Monday, April 24th at 5 pm NO EXCEPTIONS! The Tryout Application and the paperwork included in the UNCG Cheerleading Tryout Packet must be submitted directly to the UNCG Cheerleading Staff Advisor using one of the methods listed below. All tryout participants are encouraged to submit all paperwork as soon as possi-ble so any issues that may arise can be addressed prior to the final deadline..


General Tryout Information continued

Skill Requirements Stunt Requirements: Two to three stunts or stunt sequences and a 360 dismount with tryout partici-

pants determined by the coaching staff One stunt or stunt sequence, of your choice, with other tryout participants in-

cluding a minimum of one transitionJumps & Tumbling Requirements: **ALL UNCG CHEERLEADERS MUST TUMBLE! Toe touch Toe-Handspring and/or Toe-Tuck Demonstrate a minimum of 1 standing tumbling skill (Standing back handspring

or higher) Demonstrate a minimum of 1 consecutive running tumbling pass (RBHS series or

higher)**Any additional material taught during the tryout process**

**It is important that you attend both days of the tryout process. All tryout material will be taught on Thursday of the tryouts.

Scores will NOT be released. The coaching staff will make all final decisions on team mem-ber selection. Any candidate that has questions after the team selections are announced may e-mail the UNCG Cheerleading Coach at [email protected] OR [email protected] any time AFTER the weekend. Outbursts or questions from parents will not be accepted.

If you have ANY questions regarding paperwork or the general audition process, please con-tact the staff advisor in advance! Being proactive will insure you are prepared and cleared to participate in auditions.

We are looking for well-rounded cheerleaders with outstanding skills and

CHEER-LEADING ability!

We realize that not all “stunters” have advanced tumbling skills and vice versa. Be prepared to take direction and learn during the tryout process. Do not assume that a weakness or lack of skill in any one area will automatically disqualify you as a team member. Display an eager and positive attitude at all times.

Keep working on your skills! We look forward to meeting and working with you!

GO SPARTANS!


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Do you offer any partial or full scholarships for cheerleaders?

No scholarships are currently provided to UNCG Cheerleaders.

Does UNCG have a coed team or all-girl?

Currently UNCG’s Cheerleading squad consists of females only, but tryouts are open to both males and females.

What is the UNCG Cheerleading squad size?

Our maximum squad size is 20 cheerleaders and we may have alternates.

When are tryouts?

The UNCG Cheerleading Squad holds one tryout in mid April. If needed, a Fall tryout will take place but will not always occur.

What are the additional benefits of being a UNCG Cheerleader?

The UNCG Cheerleading squad is sponsored by the UNCG Athletic Department. Team members are able to pre-register for classes, have access to the Athletic Training room and staff, study hall sessions, strength and conditioning coaches, uniforms, shoes, travel accommodations and meal stipend when traveling and tickets to UNCG’s home athletic events.

Does your team compete?

Currently, the UNCG Cheerleading squad does not compete on a regular basis.

However, we have attended the NCA/NDA Collegiate National Competition in

the past.Does your team attend summer camp?

Yes, the UNCG Cheerleading squad attends a summer camp.

Does UNCG have a dance team?

Yes, the UNCG Spartan G’s Dance Team, is a part of the UNCG Spartan Spirit Program along with the UNCG Cheerleading Squad, UNCG Band of Sparta & Spartan Mascot, Spiro.

Does UNCG uphold the rules and regulations set forth by the American Association of Cheerleading Coaches and Administrators (AACCA)?

Yes, the UNCG Cheerleading squad abides by all rules and regulations set forth by AACCA. For more information on these rules and regulations visit www.aacca.com.

UNCG Dance Team Q&A UNCG Cheerleading Q&A

UNCG CHEERLEADING SQUAD AUDITION APPLICATION

GENERAL INFORMATION

NAME: _________________________________________ (First, Middle, Last)

UNCG STUDENT ID #: __________________

AGE: ________ DATE OF BIRTH: __________________ (mm/dd/yy)

CLASS RANK FOR THE 2017-18 ACADEMIC YEAR (circle one):

FRESHMAN SOPHOMORE JUNIOR SENIOR OTHER

UNCG E-MAIL ADDRESS: _________________________________________

ALTERNATIVE E-MAIL ADDRESS: _________________________________________

PERMANENT ADDRESS (PARENT’S ADDRESS): ______________________________________________________ (Street Address)

____________________________ ________ __________________ (City) (State) (Zip Code)

CELL PHONE #: _______________________ HOME PHONE #: _______________________

MAJOR: _________________________________________ EXPECTED DATE OF GRADUATION: _____________

MOTHER’S NAME: _________________________________________ CELL PHONE #: _____________________

FATHER’S NAME: _________________________________________ CELL PHONE #: _____________________

ADDITIONAL INFORMATION

DO YOU HAVE ANY CONFLICTS WITH THE TIME COMMITMENT AND EXPECTATIONS DURING THE SUMMER OR UPCOMING SEASON? (I.E. WEDDINGS, TRAVEL, STUDYING ABROAD, WORK COMMITMENTS) _____________

IF YES, PLEASE EXPLAIN: ________________________________________________________________________ ____________________________________________________________________________________________

DO YOU HAVE ANY SPECIFIC HEALTH CONDITIONS OR LIMITATIONS WE SHOULD BE AWARE OF? ____________


HAVE YOU BEEN UNDER THE CARE OF A PHYSICIAN WITHIN THE PAST YEAR? _____________________________


Page 1


CHEERLEADING BACKGROUND INFORMATION

HOW MANY YEARS HAVE YOU BEEN CHEERING? _________________________________________

PLEASE LIST THE NAMES OF TEAMS, GYMS, ETC. YOU HAVE CHEERED WITH IN THE PAST AND HOW MANY YEARS YOU WERE WITH THAT ORGANIZATION:

TEAM/GYM NAME YEARS WITH ORGANIZATION

1. _________________________________________ ___________________

2. _________________________________________ ___________________

3. _________________________________________ ___________________

WHICH STUNT POSITION WILL YOU BE AUDITIONING FOR? (check all that apply)

FLYER MAIN BASE SECONDARY BASE BACK SPOT

WHICH STANDING TUMBLING SKILLS DO YOU CURRENTLY HAVE MASTERED? (check all that apply)

BACK HANDSPRING BACK TUCK TOE HANDSPRING TOE TUCK

OTHER (please specify) __________________________________________________

WHICH RUNNING TUMBLING SKILLS DO YOU CURRENTLY HAVE MASTERED? (check all that apply)

BACK HANDSPRING SERIES BACK TUCK LAYOUT LAYOUT STEP OUT

FULL OTHER (please specify) __________________________________________________

PLEASE LIST ANY ACCOMPLISHMENTS YOU HAVE EARNED THAT YOU WOULD LIKE US TO BE AWARE OF:

__________________________________________________________________________________________________________________________________________________________________________________________

LADIES UNIFORM INFORMATION

UNIFORM TOP SIZE: XS (30-32) S (32-34) M (34-36) L (36-38)

UNIFORM SKIRT SIZE: SMALL MEDIUM MEDIUM LONG LARGE

CHEER SHOE SIZE: 5 7 9

5.5 7.5 9.5

6 8 10

6.5 8.5

TENNIS SHOE SIZE: 5 7 9

5.5 7.5 9.5

6 8 10

6.5 8.5

T-SHIRT SIZE: X-SMALL SMALL MEDIUM LARGE

SWEATSHIRT SIZE: X-SMALL SMALL MEDIUM LARGE

SWEAT PANT SIZE: X-SMALL SMALL MEDIUM LARGE

WARM-UP JACKET SIZE: X-SMALL SMALL MEDIUM LARGE

WARM-UP PANT SIZE: X-SMALL SMALL MEDIUM LARGE

SPORTS BRA SIZE: XS (30-32) S (32-34) M (34-36) L (36-38)

Page 2


MEN’S UNIFORM INFORMATION

UNIFORM TOP SIZE: SMALL MEDIUM LARGE X-LARGE

UNIFORM PANT SIZE: SMALL MEDIUM LARGE X-LARGE

CHEER SHOE SIZE: 5 7 9

5.5 7.5 9.5

6 8 10

6.5 8.5 11

TENNIS SHOE SIZE: 5 7 9

5.5 7.5 9.5

6 8 10

6.5 8.5 11

T-SHIRT SIZE: SMALL MEDIUM LARGE X-LARGE

SWEATSHIRT SIZE: SMALL MEDIUM LARGE X-LARGE

SWEAT PANT SIZE: SMALL MEDIUM LARGE X-LARGE

WARM-UP JACKET SIZE: SMALL MEDIUM LARGE X-LARGE

WARM-UP PANT SIZE: SMALL MEDIUM LARGE X-LARGE

Page 3

Appendix B

Sample print-out from UNCGenie:

Your Name Here

Appendix B

Sample print-out from UNCGenie:

UNCG CHEER AND DANCE PHYSICAL

Name: _________________________________________ Date: _____________ Sport: CHEER / DANCE

School Address: _______________________________________________________________________________

University ID: _______________ DOB: __________ Telephone Number: _______________________

Parents’ Name: _______________________________________________________________________________

Parents’ Address: ______________________________________________________________________________

List any allergies (including latex):___________________________ Last Tetanus: __________________

Medications currently taking (including birth control): ________________________________________________________________________________________________________________________________

*Please answer the questions below. Fill in details of “yes” answers in space provided.*

1. Have you ever been hospitalized? Yes No

2. Have you ever had surgery? Yes No

3. Have you ever passed out during exercise? Yes No

4. Have you ever been dizzy during exercise? Yes No

5. Have you ever had chest pain during exercise? Yes No

6. Have you ever had a head injury, seizure or unconscious? Yes No

7. Have you ever had heart trouble, or high blood pressure? Yes No

8. Has anyone in your family died suddenly before the age of 50 of heart problems? Yes No

9. Have you ever had a heat related illness?(cramps, dizzy or passed out) Yes No

10. Do you have any other medical problems?(ie asthma, diabetes, hepatitis,

Impaired function of any organ) Yes No

11. Do you have any menstrual irregularities or problems? Yes No

12. Do you wear glasses, contacts, braces of any kind, orthotics, hearing aid? Yes No

13. Have you ever injured (sprained, dislocated, fractured etc)? Circle all that apply.

Neck Chest Hip Thigh Knee Ankle Foot

Toes Lower Leg Elbow Arm Wrist Back Head

Fingers Shoulder

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

EXAMINATION

Height __________ Weight __________ RHR __________ BP __________

Heart ____________________ Lungs ____________________

Abdomen __________ General __________ Other __________

MUSCULOSKELETAL

Neck __________ Back __________ Shoulder __________ Knee __________

Elbow __________ Ankle __________ Wrist __________ Foot __________

Hip __________ Hand __________

ASSESMENT

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

RECOMMENDATION

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CLEARANCE

No Restrictions ____________________

Deferred Until ____________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________ _____________________________________ __________________ Name of Provider Signature of Provider Date

Appendix E

Health Insurance Information for 2017-18 Academic Year

Athlete’s Name__________________________________________________________ Date of Birth / /

Last First MI

Athlete’s Home Address___________________________________________________________________

___________________________________________________________________

City State Zip Code

Athlete’s University ID # Athlete’s SS#________________________

Sport _______________________________

Complete Name of Insurance Company ______________________________________________________

Address to Mail Claim ______________________________________________________

______________________________________________________

______________________________________________________

Policy Holder’s Name_________________________________________________________

Last First MI

Policy Holder’s Address __________________________________________________________________________

Number Street

__________________________________________________________________________

City State Zip Code

Policy Holder’s SS# - - Policy Holder’s DOB / /

Please copy the front and back of your insurance card and affix it below.

(Front) (Back)

Appendix F

Consent to Disclose Protected Health Information

I hereby consent to allow the UNCG Athletic Training Staff to disclose Protected Health Information

concerning any injury or athletically related illness to my coaching staff and the UNCG Athletics

Administration.

I hereby consent to allow UNCG Athletic Department Personnel to disclose Protected Health Information

concerning any injury or athletically related illness to my parents, legal guardians, or wards.

I authorize payment of medical benefits to all providers of services for all services and materials they

provide during the care of any injury/illness.

I agree to supply any and all information requested by my primary insurance, UNCG and the excess

insurance company, and the NCAA and their excess insurance company in a timely manner in order to

expedite the claim process.

I hereby authorize UNCG and their excess insurance company to secure and inspect copies of case history

records, lab reports, diagnoses, x-rays, and other data pertaining to the injury/illness I am receiving care for

or previous confinements, if disabilities relevant, to the care of the injury/illness.

I authorize the UNCG Athletic Training staff and/or my coach to hospitalize and secure treatment for me

for any athletic injury/illness. If the athlete is under 18 years of age, the undersigned parent/guardian grants

permission the UNCG Athletic Training staff and/or the coach to hospitalize and secure treatment for their

son/daughter/ward for any athletic injury/illness.

This consent is irrevocable for the duration of any executed disclosure due to an athletically related illness

or injury.

A photo static copy of this consent shall be deemed as effective and valid as the original.

I will notify the UNCG Athletic Training staff immediately upon any change in the above health insurance

information.

_____________________________________________________ ______________

Athlete’s Signature Date

_____________________________________________________ ______________

Parent/Guardian Signature Date

Parent/Guardian’s Name _________________________ Relationship______________________

Home Phone _________________________ Work Phone______________________

Parent/Guardian’s Name _________________________ Relationship______________________

Home Phone _________________________ Work Phone______________________

Alternate Person to Contact in Case of Emergency __________________________________

Relationship __________________________________

Home Phone __________________________________

Work Phone __________________________________

Appendix G

UNCG Athletics

Waiver, Release of Liability, & Indemnity Agreement

I am aware and understand that any physical activity, including (but not limited to) soccer, basketball, volleyball, tennis,

baseball, softball, cheerleading, weight lifting and conditioning, can be a dangerous activity, which may result in serious

personal injury. These injuries include, but are not limited to, serious neck and spinal injuries, complete or partial pa-

ralysis, brain damage, serious injuries to bones, joints, ligaments, and tendons; serious injury to other areas of the

body, general health and well-being, and even DEATH.

In consideration of the University of North Carolina Greensboro (UNCG) permitting me to use its Athletic Facilities, I agree to the following:

I will obey all rules established by UNCG Athletics for the use of its facilities.

I will obey any and all instructions or directions given to me by UNCG Athletic personnel concerning the use of its facili-ties.

I assume all financial responsibility for any injury or damage as a result of my use of UNCG Athletic Facilities.

To the fullest extent allowed by law, I hereby release and agree to hold harmless UNCG, its trustees, officers, agents, employees, coaches, professors, students, athletic trainers and other medical personnel from any and all liability arising out of any injuries to my person or property, or losses of any kind or nature whatsoever, which may result from, or which arise in connection with, my use of the UNCG Athletic Facilities, even to the extent that such injuries may arise from the negligence of those listed above.

To the fullest extent allowed by law, I will indemnify and hold harmless, including attorney’s fees and court costs, those

listed above for any injury to person or property that I may cause others in the course of my use of the UNCG Ath-

letics Facilities or due to my failure to obey any rules, directions, or instructions.

I acknowledge that I have read this agreement fully and that I understand the legal rights I waive by signing this agree-ment. I further acknowledge that I am aware of the potential hazards incident to engaging in physical activity.

_________________________________ ___________________________________ Signature of Participant Date Signature of UNCG Representative Date

_________________________________ ___________________________________ Printed Name of Participant Printed Name of UNCG Representative

______________________________________ __________________________________________

Printed Name of Parent/Guardian Date Signature of Parent/Guardian

Insurance Information

2017-2018

UNCG currently requires all students to have primary medical insurance. It is the responsibility of each student to prove that

he/she has medical insurance, and if not, the student account will be automatically billed per semester. The premium has not been finalized for the 2017-18 year but will be announced this summer. We strongly recommend that you research and

understand your insurance benefits prior to your arrival on campus. If the benefits are insufficient or non-existent in

NC(HMO), you may wish to call your carrier to inquire about alternatives. Another option would be to choose/default to the

school policy. Should the status of your insurance coverage change during the course of the school year, please be sure to

communicate this with the athletic training staff immediately. The UNCG Department of Intercollegiate Athletics carries an

excess insurance policy for each student-athlete to cover athletic related injuries. This policy carries a $0 deductible, per

injury.

When a student-athlete is injured during athletic participation, all medical insurance claims will be filed with your personal in-

surance company. Once your primary insurance company pays their portion of your bill, our excess policy will cover the

remain-ing balance. In order to help process payments you may be required to provide the following:

1) Itemized bills from all medical providers

2) Explanations of Benefits (EOB’s) from your medical insurance

company

All injuries must be reported to a staff athletic trainer. We will advise the student-athlete of the protocol that is recommended for

treatment and referral, and as appropriate, steps necessary to best insure proper payment by all insurance parties involved. Please

visit the student health center website to learn how to self-file charges incurred at the Student Health Center (SHC). The SHC

charges are eligible for insurance coverage, but are not submitted by the provider. Please note that charges incurred for services

at the SHC will be placed on the UNCG Student Account and lack of payment could affect future class registration, graduation

etc. At no time should the student-athlete seek medical treatment without the prior approval of the Athletic Trainer. This action

will jeopardize and/or remove responsibility from UNCG and its excess accident insurance company for payment of medical

bills.

Your signature on this letter indicates that you have read, understand and will comply with all that is stated above. Any false in-

formation will nullify UNCG from responsibility regarding any medical bills.

“I, _______________________________________ have read the above letter and understand that UNCG is responsible on a

secondary basis only for injuries which occur in an official UNCG athletic practice or competition. I also verify, that all of the

insurance information I have provided is correct and complete.”

_______________________________________ ______________________ _________________

Student-Athlete Signature UNCG Student ID # Date

_______________________________________________ _________________

Parent Signature Date

Appendix I

2017-2018 UNCG Intercollegiate Athletics Agreement,

Injury Release, Assumption of Risk, and Athlete Responsibility Form

UNCG Intercollegiate Athletic Sports:

Baseball, Basketball, Cheerleading, Cross Country, Dance, Golf, Soccer, Softball, Tennis, Track & Field, Volleyball

I am aware that trying out for, practicing or playing in any sport can be a dangerous activity involving MANY RISKS

OF INJURY. I understand the inherent potential dangers and risks of trying out for, playing and practicing in the above

intercollegiate sports may be catastrophic in nature and may include, but are not limited to, death; serious neck and spi-

nal injuries which may result in complete or partial paralysis or brain damage; serious injury to virtually all bones, joints,

ligaments, muscles, tendons and other elements of the muscular-skeletal system, including loss of limb; and serious inju-

ry or impairment to other parts of my body, general health and well-being.

Because of the dangers of participating in any of the above sports, I recognize the importance of following the coach’s

instructions regarding playing techniques, training, rules of the sport and other team rules, and of following such instruc-

tions. I also realize that during my entire athletic career at UNCG I have a responsibility to my own physical well being

and must accurately report any injury in a timely manner to the UNCG Sports Medicine Staff. I will follow the guide-

lines established by the UNCG Sports Medicine Staff for rehabilitation from any injury. If I have any questions regard-

ing my injury or care, I will ask the UNCG Sports Medicine Staff. I will also abide by the rules of the sport in which I

participate. I realize that adherence to these responsibilities in no way assures me of avoiding or lessening all injuries,

including those of catastrophic nature, but by following them, I may decrease the severity of some injuries.

In consideration of UNCG permitting me to try out for, practice, play or otherwise participate in the above listed inter-

collegiate sports and to engage in all activities related to the team, including, but not limited to practicing, playing and

traveling, I hereby voluntarily assume all risks associated with participation and agree to hold harmless The University

of North Carolina at Greensboro, its agents, officers and employees including, but not limited to, the UNCG Athletics

staff from any and all liability, claims, causes of action or demands of any kind and any nature whatsoever which may

arise by or in conjunction with my participation in any activities related to the UNCG Intercollegiate Athletics Program

except in the event of their gross negligence. The terms of this Agreement shall serve as a release and assumption of risk

for my heirs, estate, executor, administrators, assignees and all members of my family.

To the best of my knowledge, I am in good health and suffer no disability or condition which renders my participation in

the sport(s) or other athletics activity medically inadvisable, or otherwise limits my ability to participate in such sport(s)

or athletics activity without restriction.

I hereby authorize the coach or other appropriate UNCG personnel to obtain in my behalf first aid, emergency medical

care, or if necessary admission to an accredited hospital, when such care is necessary for the treatment of any injuries I

may sustain while participating in any activity associated with UNCG intercollegiate sports, including practices, compe-

tition and travel. I also hereby consent to the administration of emergency medical treatment in the event I am unable

subsequent to such injury to give such consent as otherwise necessary.

Name_________________________________________________ Date of Birth _________________

Signature_______________________________________________ Date ________________________

Parent/Guardian Signature _________________________________ Date_________________________

(if student-athlete is less than 18 years of age)

Appendix J

UNIVERSITY OF NORTH CAROLINA at GREENSBORO SPORTS MEDICINE

Sickle Cell Trait Screening Declination and Release of Claims

**Must submit this form along with Sickle Cell Results

(signing this form is NOT a replacement for testing, still must have Sickle Cell trait screening)

About Sickle Cell Trait: Sickle cell trait is an inherited condition of the oxygen-carrying protein, hemoglobin, in the red blood cells.

Sickle cell trait is a common condition (> three million Americans).

Although Sickle cell trait is most predominant in African-Americans and those of Mediterranean, Middle Eastern, India, Caribbean, and

South and Central American ancestry, persons of all races and ancestry may test positive for sickle cell trait.

Sickle cell trait is usually benign, but during or after exercise, hypoxia(lack of oxygen) in the muscles may cause sickling of red blood cells

(red blood cells changing from a normal disc shape to a crescent or “sickle” shape), which can accumulate in the bloodstream and

“logjam” blood vessels, leading to collapse, personal injury and/or DEATH from the rapid breakdown of muscles starved of blood.

If the UNCG Sports Medicine Staff and the student-athlete’s coaches are made aware that a student-athlete has sickle cell trait, then col-

lapse, personal injury and/or DEATH from exercise may be avoided or decreased if the student-athlete follows the directives of the

Staff and his/her medical professionals. Such directives may include, but not be limited to, reduced or modified activity during prac-

tice and/or games.

Sickle Cell Screening: If the student-athlete does not have knowledge of their sickle cell trait status, the NCAA recommends that screening is performed. In order

to decrease the risk of collapse, personal injury and/or DEATH to its student-athletes, the University of North Carolina Greensboro

requires that all student-athletes who do not know their sickle cell status undergo the screening.

I ,______________________________, (parent or guardian name here if student-athlete is under 18)understand and

acknowledge that, in order to decrease the risk of collapse, personal injury and/or DEATH to its student-athletes the

University of North Carolina at Greensboro recommends that all student-athletes have knowledge of their sickle cell trait

status. Additionally, I have read and fully understand the aforementioned facts about sickle cell trait and sickle cell trait

testing. I understand that exercising without knowledge of sickle cell trait status can increase the risk of collapse, personal

injury and/or DEATH during or after exercise.

I hereby affirm that I have fully and accurately disclosed in writing any prior medical history and/or knowledge of sickle

cell trait status to UNCG Athletic Training staff.

I do not wish to undergo sickle cell trait testing (in the case of a minor, the parent or guardian does not wish the minor to

undergo sickle cell trait testing) through UNCG, as I (or my dependent) has been screened previously and I am able to pro-

vide these results. I (or in the case of a minor the parent or guardian) voluntarily agree to release, indemnify and hold harm-

less, regardless of their negligence, the State of North Carolina, the University of North Carolina at Greensboro, its officers,

employees, agents and volunteers from any and all costs, liabilities, expenses, claims, demands, or causes of action on ac-

count of any loss, personal injury or DEATH that might result from this decision to not be screened for sickle cell trait and/

or from any incorrect information that I or any person on my behalf provided to UNCG Athletic Training staff about sickle

cell trait status.

I have read and signed this document with full knowledge that I may be giving up rights that I may otherwise be entitled to

if I had not signed it. I am at least 18 years of age and competent to sign this waiver.

_________________________________________ ____________________________________

Student-Athlete Signature Date

_________________________________________ ____________________________________

Sport University ID#

_________________________________________ ____________________________________

Parent/Guardian Signature Date

_________________________________________ ____________________________________

uncg cheerleading

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