2017 Islanders Cheer & Dance Recruit Prep Clinic
2017 Islanders Cheer & Dance Recruit Prep Clinic Registration Form February 4, 2017 University Center 2:00 pm – 6:00 pm Please Check all that Apply: _______ Cheer _______ Dance _______ Mascot NAME (Last)
GENDER (Check one) Male
(First)
(Middle)
Female
BIRTH DATE (MM/DD/YYYY)
MAILING ADDRESS CITY
STATE
HOME PHONE #
ZIP CODE
CELL #
EMAIL
CURRENT GPA
HIGH SCHOOL (if applicable)
ALL-STAR GYM/DANCE STUDIO (if applicable) T-SHIRT SIZE _
CURRENT GRADE (circle one)
LEVEL
9th
10th
11th
Please Check UP TO TWO That Apply (Cheerleading Females Only): !! I have experience being a Coed Flyer !! I have experience being an All-Girl Flyer !! I am a back spot !! I am a main base (holding toe and heel) !! I am a secondary base (holding the middle of the foot)
12th
College
2017 Islanders Cheer & Dance Recruit Prep Clinic v Registration and group social begins at 2:00 pm in the University Center v An optional tour will begin at 3:00 pm and group stunt and dance technique will begin at 4:00 pm. The clinic should wrap up no later than 6:00 pm. v A full meal will be not be provided but a snack and drinks will be available during the social hour. v We will have a 15-minute break after the tour for you to change so that you can prepared to tumble, stunt, dance, and cheer. v This is a very informal clinic, so there is no reason to be nervous or intimidated. v This clinic’s purpose is to familiarize you with the TAMUCC’s style of cheerleading and dance. v Parents are welcome to attend
Payment Info Pre-Registration Clinic Fee is $25.00 (CASH or CHECK only - checks made payable to TAMUCC Spirit - $25 charge on all returned checks…NO REFUNDS) If pre-registering, your payment, registration form, & SIGNED release agreement are due by Jan 27, 2017 These items should be mailed to the address found at the bottom of this form. Pre-registering insures that you receive a t-shirt the day of the event in the size of your choosing. We highly encourage you to register by the January 27th deadline. Day of Clinic Fee is $30.00 (Cash, Check, or Money Order will be the only form of payment accepted at check-in on the day of the clinic.) If registering day of the clinic, you will need your payment, registration form, & SIGNED release agreement at check-in. You and your parent/guardian (if under 18 yrs. old) must sign the Student Release Form. **Please note that if you are registering after the Jan 27th deadline you are not guaranteed a t-shirt in your size. We will do our best to get you your correct shirt size but, may need to mail it to you after the event.
For More Information please contact Melanie Lowry at [email protected] or 361-825-3417 All Checks should be made out to TAMUCC Spirit. Please mail the completed forms and payment to the following address: 6300 Ocean Drive, Unit 5719, Corpus Christi TX 78412
Student Activity Release Form The Texas A&M University System I, , understand and agree that the officially-sponsored activities of Texas A&M University-Corpus Christi involve certain known risks, including but not limited to, transportation accidents, personal injuries, and loss or destruction of my property. I understand and agree that Texas A&M University-Corpus Christi cannot be expected to control all of said risks. In consideration of the benefits I will receive through my participation in the activities of the Texas A&M University-Corpus Christi_ (club name). I hereby expressly and knowingly RELEASE TEXAS A&M UNIVERSITY-CORPUS CHRISTI, ITS OFFICERS, AGENTS, VOLUNTEERS, AND EMPLOYEES FROM ANY AND ALL CLAIMS AND CAUSES OF ACTION I MAY HAVE FOR PROPERTY DAMAGE, PERSONAL INJURY OR DEATH SUSTAINED BY ME ARISING OUT OF ANY TRAVEL OR ACTIVITY CONDUCTED BY, OR UNDER THE AUSPICES OF TEXAS A&M UNIVERSITY-CORPUS CHRISTI, WHETHER CAUSED BY MY OWN NEGLIGENCE OR THE NEGLIGENCE OF TEXAS A&M UNIVERSITY-CORPUS CHRISTI, ITS OFFICERS, AGENTS, VOLUNTEERS, OR EMPLOYEES. I hereby give my consent for any medical treatment that may be required during my participation with the understanding that the cost of any such treatment will be my responsibility. Further, I voluntarily and knowingly agree to HOLD HARMLESS, PROTECT, AND INDEMNIFY TEXAS A&M UNIVERSITY-CORPUS CHRISTI, its officers, agents, volunteers, and employees, against and from any and all claims, demands, or causes of action for property damage, personal injury or death, including defense costs and attorney’s fees, arising out of my participation in the activities of TEXAS A&M UNIVERSITY-CORPUS CHRISTI, REGARDLESS OF WHETHER SUCH DAMAGES, INJURY, OR DEATH ARE CAUSED BY MY OWN NEGLIGENCE, OR BY THE NEGLIGENCE OF TEXAS A&M UNIVERSITY-CORPUS CHRISTI, ITS OFFICERS, AGENTS, VOLUNTEERS, OR EMPLOYEES. Texas A&M University-Corpus Christi shall notify me promptly in writing of any claim or action brought against it in connection with my participation in these activities. Upon such notification, I or my representative shall promptly take over and defend any such claim or action. I HAVE READ AND UNDERSTOOD THIS DOCUMENT, AND MY SIGNATURE EVIDENCES MY INTENT TO BE BOUND BY ITS TERMS.
Student’s Signature
Date
Parent’s Signature (if student is under 18) Date
Emergency Information Full name Birthday
Preferred name Gender
Phone
Address
City_
State_
College Status FR SO JR SR or High School
Email_
Emergency Contact_
Relationship_
Home Phone
Alternate Phone_
City_ Medical
Zip
State_ conditions
we
should
Email know
Drug allergies_ Medications you are currently taking (prescription and nonprescription) Physician’s name_
Phone
Insurance company
Policy #_
Name of policy holder
Group #
Employer
I hereby authorize Texas A&M University-Corpus Christi to release information pertaining to myself in the event of an emergency. This information will be made available to organizational officers and advisor(s), Student Activities staff and the University Police Department. Signature of Student
Date Signature of parent or guardian (if under 18 years of age)
Printed name of parent or guardian
Date
about
GENDER (Check one) Male
(First)
(Middle)
Female
BIRTH DATE (MM/DD/YYYY)
MAILING ADDRESS CITY
STATE
HOME PHONE #
ZIP CODE
CELL #
CURRENT GPA
HIGH SCHOOL (if applicable)
ALL-STAR GYM/DANCE STUDIO (if applicable) T-SHIRT SIZE _
CURRENT GRADE (circle one)
LEVEL
9th
10th
11th
Please Check UP TO TWO That Apply (Cheerleading Females Only): !! I have experience being a Coed Flyer !! I have experience being an All-Girl Flyer !! I am a back spot !! I am a main base (holding toe and heel) !! I am a secondary base (holding the middle of the foot)
12th
College
2017 Islanders Cheer & Dance Recruit Prep Clinic v Registration and group social begins at 2:00 pm in the University Center v An optional tour will begin at 3:00 pm and group stunt and dance technique will begin at 4:00 pm. The clinic should wrap up no later than 6:00 pm. v A full meal will be not be provided but a snack and drinks will be available during the social hour. v We will have a 15-minute break after the tour for you to change so that you can prepared to tumble, stunt, dance, and cheer. v This is a very informal clinic, so there is no reason to be nervous or intimidated. v This clinic’s purpose is to familiarize you with the TAMUCC’s style of cheerleading and dance. v Parents are welcome to attend
Payment Info Pre-Registration Clinic Fee is $25.00 (CASH or CHECK only - checks made payable to TAMUCC Spirit - $25 charge on all returned checks…NO REFUNDS) If pre-registering, your payment, registration form, & SIGNED release agreement are due by Jan 27, 2017 These items should be mailed to the address found at the bottom of this form. Pre-registering insures that you receive a t-shirt the day of the event in the size of your choosing. We highly encourage you to register by the January 27th deadline. Day of Clinic Fee is $30.00 (Cash, Check, or Money Order will be the only form of payment accepted at check-in on the day of the clinic.) If registering day of the clinic, you will need your payment, registration form, & SIGNED release agreement at check-in. You and your parent/guardian (if under 18 yrs. old) must sign the Student Release Form. **Please note that if you are registering after the Jan 27th deadline you are not guaranteed a t-shirt in your size. We will do our best to get you your correct shirt size but, may need to mail it to you after the event.
For More Information please contact Melanie Lowry at [email protected] or 361-825-3417 All Checks should be made out to TAMUCC Spirit. Please mail the completed forms and payment to the following address: 6300 Ocean Drive, Unit 5719, Corpus Christi TX 78412
Student Activity Release Form The Texas A&M University System I, , understand and agree that the officially-sponsored activities of Texas A&M University-Corpus Christi involve certain known risks, including but not limited to, transportation accidents, personal injuries, and loss or destruction of my property. I understand and agree that Texas A&M University-Corpus Christi cannot be expected to control all of said risks. In consideration of the benefits I will receive through my participation in the activities of the Texas A&M University-Corpus Christi_ (club name). I hereby expressly and knowingly RELEASE TEXAS A&M UNIVERSITY-CORPUS CHRISTI, ITS OFFICERS, AGENTS, VOLUNTEERS, AND EMPLOYEES FROM ANY AND ALL CLAIMS AND CAUSES OF ACTION I MAY HAVE FOR PROPERTY DAMAGE, PERSONAL INJURY OR DEATH SUSTAINED BY ME ARISING OUT OF ANY TRAVEL OR ACTIVITY CONDUCTED BY, OR UNDER THE AUSPICES OF TEXAS A&M UNIVERSITY-CORPUS CHRISTI, WHETHER CAUSED BY MY OWN NEGLIGENCE OR THE NEGLIGENCE OF TEXAS A&M UNIVERSITY-CORPUS CHRISTI, ITS OFFICERS, AGENTS, VOLUNTEERS, OR EMPLOYEES. I hereby give my consent for any medical treatment that may be required during my participation with the understanding that the cost of any such treatment will be my responsibility. Further, I voluntarily and knowingly agree to HOLD HARMLESS, PROTECT, AND INDEMNIFY TEXAS A&M UNIVERSITY-CORPUS CHRISTI, its officers, agents, volunteers, and employees, against and from any and all claims, demands, or causes of action for property damage, personal injury or death, including defense costs and attorney’s fees, arising out of my participation in the activities of TEXAS A&M UNIVERSITY-CORPUS CHRISTI, REGARDLESS OF WHETHER SUCH DAMAGES, INJURY, OR DEATH ARE CAUSED BY MY OWN NEGLIGENCE, OR BY THE NEGLIGENCE OF TEXAS A&M UNIVERSITY-CORPUS CHRISTI, ITS OFFICERS, AGENTS, VOLUNTEERS, OR EMPLOYEES. Texas A&M University-Corpus Christi shall notify me promptly in writing of any claim or action brought against it in connection with my participation in these activities. Upon such notification, I or my representative shall promptly take over and defend any such claim or action. I HAVE READ AND UNDERSTOOD THIS DOCUMENT, AND MY SIGNATURE EVIDENCES MY INTENT TO BE BOUND BY ITS TERMS.
Student’s Signature
Date
Parent’s Signature (if student is under 18) Date
Emergency Information Full name Birthday
Preferred name Gender
Phone
Address
City_
State_
College Status FR SO JR SR or High School
Email_
Emergency Contact_
Relationship_
Home Phone
Alternate Phone_
City_ Medical
Zip
State_ conditions
we
should
Email know
Drug allergies_ Medications you are currently taking (prescription and nonprescription) Physician’s name_
Phone
Insurance company
Policy #_
Name of policy holder
Group #
Employer
I hereby authorize Texas A&M University-Corpus Christi to release information pertaining to myself in the event of an emergency. This information will be made available to organizational officers and advisor(s), Student Activities staff and the University Police Department. Signature of Student
Date Signature of parent or guardian (if under 18 years of age)
Printed name of parent or guardian
Date
about
