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Application for Rock Springs Middle School Basketball Cheerleading Tryouts My child, _______________________________________ has my permission to be a cheerleader at Rock Springs Middle School. I understand that he/she must abide by the rules and regulations set forth by the coach and the principal of Rock Springs Middle School and be present for all practices and games. I have read the covenant and understand that the violation of any of these rules may lead to temporary or permanent suspension from the squad. I understand and give permission for my daughter/son to ride with other parents when necessary. I understand that all forms attached must be completed and returned by March 6th, 2012, or my child will not be allowed to tryout. I understand that my child must attend all practices (unless excused by the coach) and tryout sessions or my child will not be considered for a cheerleading position. I understand/agree by the very nature of the activity, cheerleading and gymnastics carry a risk of physical injury. No matter how careful the participant and coach are, how many spotters are used, or what landing surface is used, the risk cannot be eliminated. The risk of injury includes minor injuries such as muscle pulls, dislocation and broken bones. The risk also includes catastrophic injuries such as permanent paralysis or even death from landing or falls on the back, neck, or head. I understand these risks and will not hold Rock Springs Middle School or any of its personnel responsible in the case of an accident or injury at any time. _____________________________________________ _____________________ Parent or Guardian Date I am interested in being a basketball cheerleader at Rock Springs Middle School. I understand the risks stated above. If elected, I promise to abide by the rules and regulations set forth by the coach and the principal of RSMS. I promise to cooperate and follow the instructions of the cheerleading coach. OTHER INFORMATION: Are you currently a member of any club, organization, or team requiring practice time? If yes, please list: _________________________________________________________________ Please list any obligations that may interfere with summer practices/camps: __________________________________________________________________________ Please list any previous cheerleading/dance/gymnastics experience: ____________________ ___________________________________________________________________________ Student Name: _________________________________ Date: ________________ Home Address: _________________________________________________________ School now attending: ____________________________ Grade next year: _______ In order to tryout for cheerleading at Rock Springs Middle School, you will have to get a copy of your report card for the current year and get two teacher evaluation forms filled out. Return these by March 13th, 2012, to Adriel Duncan at Rock Springs Middle School. Failing grades including “D’s”, OSS/ISS, low score on teacher evaluation forms or removal from any Athletic or Academic activity will make you ineligible for tryouts. Teacher Recommendation (From 2 current teachers) Dear Teacher: Please evaluate ______________________________________ on the following qualities and return this form to my mailbox by March 1st. Please do not give this form back to the cheerleading candidate. Thank you for taking the time to fill out this recommendation. Adriel Duncan 7th grade Language/Cheer Coach Please give 1 (lowest) to 10 (highest) based on your opinion of the following: 1. Maturity ______ 2. Dependability ______ 3. Cooperation with others ______ 4. Behavior in classroom ______ 5. Leadership qualities ______ 6. School spirit ______ 7. Attitude ______ 8. Ability to handle problems ______ Current grade in your class: ___________ Number of absences: ___________ Print Name: _____________________________ Teacher Signature: ________________________ Additional Comments: February 15, 2012 Dear parents/guardians: Thank you for your interest in your child’s participation in cheering for RSM. The 2012-2013 year will be the start of something new for our school. We will have two squads next year, one for football/competition and one for basketball. The football/competition squad will be taking approximately 16 girls or boys and the basketball squad will be taking 12 girls or boys. Tryouts are as follows for the Football/Comp squad: MARCH 2nd: 1st clinic day…teach the dance; 3:30 – 5:00 MARCH 5th: 2nd clinic day…review the dance & teach cheer; 3:30 – 5:00 MARCH 6th: 3rd clinic day…review cheer & put into groups; 3:30 – 5:00 MARCH 7th: 4th clinic day…review dance, cheer, and tryout timeline; 3:30 – 5:00 MARCH 8th: off to practice MARCH 9th: Try-outs from 3:45 – 5:45 Tryouts are as follows for the Basketball squad: MARCH 13th & 14th: clinic days-teach the dance and sideline cheer MARCH 15th: Off to practice the routines MARCH 16th: try-outs from 3:45-5:45. I will take the students in numerical order approximately 3-5 girls at a time to be judged. Students will need to be picked up immediately following their try-out. After all students have been judged, the scores will be tallied and a list will be posted on the front door of the school by number. If you have decided your child will try-out for the Basketball squad March 13, 14, and 16, there is a mandatory parent meeting on March 6th at 5:30 p.m. at Rock Springs Middle. At this time, I will give out more information about the financial and time commitments involved so that you can better decide if your child should participate. Applications for tryouts can be picked up in the office of your child’s school and must be returned by March 1st. If your child is selected for the basketball squad there will be a mandatory parent meeting Monday, March 26th in which additional information will be provided, including calendars through the month of July. If you have any questions about the Football/Competition squad, you may contact Mrs. Honeycutt at 904-3825 x 29311 and if you have any questions about the Basketball squad, you may contact Ms. Duncan at 904-3825 x 29379. Looking forward to a great season! Adriel Duncan 7th Grade Language Arts/Cheer Coach Rock Springs Middle School Cheerleading Covenant I. Purpose To promote and uphold school spirit, develop a sense of good sportsmanship among the students, and to build better relationships between schools during athletic events. To represent Rock Springs Middle School in games and competitions. II. Participation Cheerleaders are expected to be at all cheerleading activities. Excused absences are school-related activities, death in family or major illness with a doctor’s note. Unexcused absences are non- school related activities, work, mild sickness (including headaches, cramps, etc.). Doctor/dentist appointments are not excused. These need to be planned around cheerleading practices and events. After 2 unexcused absences, the cheerleader may be considered for dismissal from the squad or suspension. Cheerleaders must notify the coach if they are going to be absent. Failure to do so will result in an automatic unexcused absence. Cheerleading must be the first priority. If you participate in other sports, missing any cheerleading activity for other sports could result from dismissal from the squad. Gymnastics is considered a practice and will be treated as such. III. Tardies/Early Leave Tardies to or early leave from a practice or activity will result in extra conditioning (or other consequences set by the coach). If the requirements are not satisfied before a game, competition, or activities, the cheerleader will not be able to participate. If this is a frequent problem or if late notice is given, the amount of time being late to/leaving from practice can add up to an unexcused day of practice. Cheerleaders must be in attendance for school at least half of the day of a game/practice in order to participate. Some exceptions could be made on an individual basis at the coach’s and/or administrations’ discretion. Should school be cancelled on the day of a game/practice, the coach will inform you as to whether or not you will still participate. Do not make other plans until notified by the coach. Excessive absences from school could result in dismissal from squad. IV. Work It is almost impossible for cheerleaders to have jobs. There are often situations in which we have to change our practice times. Work is never an excused absence from cheerleading. V. Cheerleading Protocol The following are not acceptable and will not be tolerated: Talking excessively during games to other cheerleaders Talking during a game to spectators Chewing gum at games or practices Romancing with boyfriend/girlfriend while in uniform (no physical contact) Cursing or vulgar language Talking during the National Anthem/Silent time or while a player is injured Talking during instruction time during practice or game Complaining Gossip/Disrespect to other squad members Any of the above in excess may be grounds for dismissal from squad, benching of game and/or immediate consequence of extra conditioning at the coach’s discretion. If a cheerleader is benched, he/she will sit with the coach the entire length of the activity with no socializing. Disrespect to administration, faculty, staff or disrespect to cheer coaches may result in immediate dismissal from squad. If you are a parent who causes issues (ex: failure to make payments, constant complaining, negative remarks/gossiping, arguing with coach or parents, etc.) for the coach, your child will be removed from the cheerleading squad. NO QUESTIONS ASKED! This is the coach’s decision. No member is irreplaceable and will not be treated as such. Always remember: for every member chosen, there are many who would love to take their place. Other grounds for dismissal or suspension: VI. Poor health (causing excessive absences and/or not being able to perform duties required) VII. Smoking, drinking, or using drugs VIII. Failing “F” one subject in school for a nine weeks results in dismissal from the squad. First ”D” results in suspension and 2nd “D” results in dismissal even if during the same grading period. IX. Getting in trouble with law enforcement X. Inability to get along with other cheerleaders XI. Benched more than 3 times XII. OSS or ISS may result in dismissal from the squad. This will be determined on an individual basis by the coach and administrators. XIII. Coach’s discretion/overall good of the squad XIV. Past due payment for gymnastics could result in dismissal from the squad. It is a privilege to be a part of the Rock Springs Middle School Cheerleading Squad and each member will act in a respectable manner. You start representing Rock Springs Middle School the minute you become a part of any RSMS Cheer Squad. Your actions reflect back on your teammates and school. Removal from the squad will result in removal from the squad gymnastic class. XV. Appearance, Uniforms and Equipment Hair must be pulled back for all games/practices. Jewelry of any kind may not be worn to any game/practice/competition. This includes tongue rings, belly rings, earrings, rings, necklaces, or bracelets. (Medical alert charms and religious medals are exceptions but must be taped to the body.) This is for safety reasons and is a National Cheerleading Rule! Cheerleaders may not have nails that can be seen over the fingertips. (No acrylic or gel nails.) All uniforms are property of Rock Springs Middle School No one may change out of the uniform during an event. (Example: At a basketball game, everyone must remain in full uniform from the time we get to the game to the time we leave.) Uniforms will not be worn except for games and designated activities. Uniform will not be worn outside of these unless the entire squad is together. (Example: Do not wear your uniform to a restaurant unless with the entire squad. Sweat suit or wind suit is allowed.) Lost or damaged uniforms are the responsibility of the cheerleader. The cheerleader who lost or damaged the uniform incurs the cost of replacing the uniform. XVI. Transportation Cheerleaders will have to be transported to and from the games/practices by a parent. The coach will not transport cheerleaders in her car. It is the responsibility of the cheerleader to find rides to and from games and other activities. XVII. Fundraising/Expenses Each year we will have several fundraisers. Cheerleaders are required to participate in all fundraisers. At least one parent must accompany the cheerleader to all fundraisers. If a parent and cheerleader are not present at the fundraisers or does not meet minimum money requirements during a fundraiser, that cheerleader could be withheld from a competition or the parent will have to compensate the cost. Check Fee: The parent/guardian will be responsible for the returned check fee $25.00 plus cost of the check. All expenses from the point of a returned check will have to be paid with money order or cash. Out of town accommodations for parents is the responsibility of the parent. It is the responsibility of the parent to inquire about cost, due date, cancellation policy, etc. If a parent does not check this information it is not the fault of the coach. I have read the Rock Springs Middle School Cheer Covenant and I agree to follow the stated rules and regulations. I recognize that there will be no exceptions to this covenant without full approval from the cheerleading coach. Cheerleader: _______________________________ _______________ Signature Date Parent: ____________________________________ _______________ Signature Date EMERGENCY TREATMENT To All Parents: Since the malpractice question has come to the forefront, many hospitals and doctors will not treat a child without parent’s consent (unless a matter of life or death). It is requested that you complete the information below so that if your child requires a visit to the hospital while under the supervision of the school, this will allow the hospital to treat the injury. EMERGENCY INFORMATION Name: __________________________________________ Sport: _____________________________________ Sex: M______ F _____ Grade: _______________ Age: _____________ Date of Birth: _____________________ Parent’s Name: ______________________________________________________________________________ _________________________ Father’s SS #: _______________________________________________ Mother’s SS#: __________________________________________________ Work Address: ______________________________________________________________________________ ________________________________ Phone Number: __________________________________________________ Home Address: ______________________________________________________________________________ ________________________________ Phone Number: _________________________________________________ Another Person to Contact: ______________________________________________________________________________ ______________________ Relationship: _________________________________________ Phone Number: _________________________________________________ Insurance Name: ______________________________________________________________________________ ______________________________ Policy and Group Number: ______________________________________________________________________________ ________________ ALLERGIES: ______________________________________________________________________________ _________________________________ Consent Statement Authorizing Treatment Parent’s Signature: ______________________________________________________________________________ _____________________________ Student’s Signature (if over age 18): ______________________________________________________________________________ _______________ PARENT’S CONSENT I herby give my consent for _______________________________________________________ to represent ___________________________________ (Name of Student) (Name of School) in the sport of __________________________________________. Exhibit 5-22 PERSONAL AFFIDAVIT IN LIEU OF SCHOOL INSURANCE All students who participate in any school – sponsored athletic sport must take out school insurance or file with the principal an affidavit form that they or their insurance company will be responsible for payment in case of injury. STATE OF TENNESSEE RUTHERFORD COUNTY SCHOOL SYSTEM I / we __________________________________________________________________ make oath in due form of law that (Printed Name of Parent/Legal Guardian) I / we am / are the parent(s) or legal guardians of _____________________________________________________________ (Printed name of Student) who is a student of Smyrna Middle School and that I / we hereby join in the application of said applicant: (Check One) _________________ 1. to be personally ___________________ 2. to have my / our insurance company responsible for payment of any injury sustained at the home or visiting school while participating in school-sponsored sports. __________________________________ _____________________________________________________ Date Signature of Parent / Guardian If Number 2 is checked: _________________________________________________ _________________________________ Name of Insurance Company Policy Number Sworn to and subscribed before me this the ________________ day of _______________, 20_________. _________________________________ Notary Public My commission expires ____________________________.
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