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POTTSBORO ISD HIGH SCHOOL/MIDDLE SCHOOL CHEERLEADER CONSTITUTION 2016-2017 Approved 02/04/16

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POTTSBORO ISD

HIGH SCHOOL/MIDDLE SCHOOL

CHEERLEADER CONSTITUTION

2016-2017

Approved 02/04/16

- 2 -

POTTSBORO INDEPENDENT SCHOOL DISTRICT

HIGH SCHOOL/MIDDLE SCHOOL

CHEERLEADER CONSTITUTION

TABLE OF CONTENTS

Article I – Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 3

Article II – Tryout Qualifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 3

Article III – Tryout Procedures and Judging . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 3

Article IV – Post Election Period Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 4

Article V – Summer Camp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 4

Article VI – Practice Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 4

Article VII – Travel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 5

Article VIII – Role of the Mascot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 5

Article IX – Mascot Elections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 5

Article X – Pep Rallies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 5

Article XI – Game Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 5

Article XII – Grooming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 6

Article XIII – Uniforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 6

Article XIV – Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 6

Article XV – Conduct . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 6

Article XVI – Sponsor Duties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 7

Article XVII – Head Cheerleader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 8

Article XVIII – Financial Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Article XIX – Competitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 9

Page 10

Article XX – Demerits………………………………………………………….

Article XIX – Letter Jackets and Awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 10

Page 14

Acknowledgement of Handbook Information. . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 15

Application/Medical/Release. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 16

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POTTSBORO INDEPENDENT SCHOOL DISTRICT

HIGH SCHOOL/MIDDLE SCHOOL

CHEERLEADER CONSTITUTION

ARTICLE I – PURPOSE

A. To promote school spirit throughout the year.

B. To encourage good sportsmanship among the fans.

C. To uphold positive relationships between schools during all athletic

events.

D. To establish the high personal ideals and good character expected of a

high school cheerleader in the Pottsboro Independent School District.

ARTICLE II – TRYOUT QUALIFICATIONS

A. Grade Eligibility: Will follow UIL guidelines for “No Pass/No Play.”

B. AP courses will be weighted proportionally.

C. Students must meet the 90% attendance rule for all classes.

D. A permission slip explaining estimated expenses and other constitutional

requirements must be signed by the parents or legal guardians and

returned to the school prior to tryouts.

E. Any student from the sixth grade through the junior year may be permitted

to try out for cheerleader that is currently enrolled in PISD at the time of

try outs.

F. Once a cheerleader has been dismissed from any squad for failure to

uphold the constitution or has resigned, the cheerleader cannot tryout the

following year. The school administration may review the reason and

grant an exception under certain circumstances. Student handbook

violations will also be considered when determining qualifications.

ARTICLE III – TRYOUT PROCEDURES AND JUDGING

A. Middle School - The number of cheerleaders on a squad will be as

follows:

7th Grade – if at least 9 students tryout – 6 members

8th Grade – if at least 9 students tryout – 6 members

If either 7th or 8th grade have less than 9 students tryout, there will be only

one combined squad up to 12 members.

1 - Mascot

High School – The number of cheerleaders on a squad will be as follows:

Varsity—up to 16 girls and 4 boys with 1 mascot

Jr. Varsity—up to 12 girls and 2 boys with 1 mascot

(No freshmen will cheer on Varsity. Seniors may only cheer on varsity.)

B. Tryouts will be held during the spring semester of the school year.

C. The 100 point scoring system will be as follows:

High School: Total of 100% = 100% Judges

Middle School: Total of 100% =100% Judges

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D. Those trying out will perform as a squad and as an individual in front of

the judges. Numbers will be drawn so that all participants will have an

equal opportunity before the judges.

E. Tryout material and specific format will be at the discretion of the

sponsor.

ARTICLE IV – POST ELECTION PERIOD PROCEDURES

A. A head cheerleader will be nominated by the sponsor and may be based on

the candidates’ experience.

B. The cheerleaders and sponsor must choose all uniforms for cheering and

camp.

C. A cheerleader is required to abide by the constitution immediately upon

election.

D. Cheerleaders should be familiar with the constitution, school song, and

fight song.

E. All University Interscholastic League (UIL) guidelines will be followed.

A six weeks grade below 70 will result in a suspension from all activities

for the given period of time as defined by the “No Pass/No Play”

guidelines.

F. Cheerleaders will continue to be responsible for all duties for the school

year.

ARTICLE V – SUMMER CAMP

A. Summer camp is required for cheerleaders.

B. Any group attending a cheerleading camp is representing its school and

must act accordingly.

C. Everyone must attend classes and competition as a group.

D. Summer camps must be within a radius of 200 miles.

E. Sponsor will attend camp and/or clinic.

F. Rules not followed at camp—cheerleader will be sent home and dismissed

from the squad.

G. Hazing will not be tolerated. Hazing will be defined at sponsor’s

discretion.

ARTICLE VI – PRACTICE SCHEDULE

A. Summer practice is required.

B. Only cheerleaders, mascot and sponsor will attend practice sessions.

C. Summer duties will include preparation for camp and making spirit signs.

D. The cheerleading squad will follow established UIL regulations limiting

the out-of-school workouts to 8 hours per week during the school year.

E. Practice will be called sessions by the sponsor.

ARTICLE VII – TRAVEL

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A. Cheerleaders traveling to football games will accompany the band van/bus

unless a cheerleading van/bus is taken. The sponsor will accompany

them. The cheerleaders must ride the van/bus to and from the activities or

ride home with their parent or legal guardian. (If there are any special

arrangements, the sponsor must be notified by the parents in writing prior

to the departure of the cheerleading squad.)

B. Written permission slips can be used at the games with sponsor

/administrator’s approval.

ARTICLE VIII – ROLE OF THE MASCOT

A. Work with all spirit groups.

B. Attend all practice sessions.

C. Use game antics and pantomime to increase spirit.

D. Be organized at all times.

E. Know cheers and chants.

F. Wear appropriate uniform.

ARTICLE IX – MASCOT ELECTIONS

Refer to Article II.

ARTICLE X – PEP RALLIES

A. Cheerleaders and mascot will wear the proper uniforms.

B. The purpose of the pep rally is to instill good sportsmanship and to

motivate those individuals in attendance.

C. Cheerleaders will be expected to give 100% of their energies at all pep

rallies.

D. Post-season play in all sports – organized pep rallies with the approval of

the building principal.

ARTICLE XI – GAME RESPONSIBILITIES

A. All cheerleaders must attend every scheduled function.

B. Cheerleaders will be responsible for their assigned equipment. The

cheerleader sponsor will set a rotation schedule for all equipment

responsibilities.

C. Cheerleaders will be at assigned games at least 30 minutes prior to the

game.

D. Varsity cheerleaders must cheer at all football games and at basketball and

volleyball home games and other games/events as assigned.

E. Jr. Varsity cheerleaders must cheer at all football games and will cheer at

home basketball games and other games/events as assigned.

F. Jr. High will cheer at all football games and other games/events as

assigned.

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ARTICLE XII – GROOMING

While practicing or performing, cheerleaders;

1. Will not wear heavy make-up, fake nails, or inappropriate nail

polish.

2. Will not wear jewelry. Studs are acceptable.

3. Will keep hair clean and pulled up into a ponytail.

4. Will not chew gum.

5. Will keep shoes/uniform clean for each event.

ARTICLE XIII – UNIFORMS

A. Uniforms must be clean and neatly pressed at all times.

B. When in uniform or at practice, the sponsor will establish appearance

guidelines and have the final say.

C. All uniforms at any required function will be exactly alike in its entirety,

including, but not limited to: socks, jackets, shells, wind suits, warm-up

tights, etc.

D. Cheerleaders will be expected to display no affection while in uniform.

E. A cheerleader/mascot is responsible for all items issued to him/her.

Uniforms are to be cleaned before they are returned. If the uniforms are

not returned, the cheerleader/mascot will pay for the cost of replacement.

The cheerleader will also be responsible for the costs of mends and

repairs.

F. Skirt length will be at the discretion of the sponsor and building principal.

G. Uniforms should be red and white in color and any deviation from these

colors will be approved by the Principal.

H. All uniforms will be approved by the Principal.

I. No uniforms will be worn during regular class periods without warm up

suits.

ARTICLE XIV – COSTS

A. Uniforms will be purchased by the school.

B. Each cheerleader will purchase shoes, socks, tights, briefs, windsuits etc.

C. Cheerleaders will be responsible for all camp expenses including tuition,

room and board, camp uniforms, traveling expenses and spending money.

D. Jackets and school emblems are optional.

E. The district will provide shells, skirts, sleeves, and pom pons.

ARTICLE XV – CONDUCT

A. Gum chewing and eating of candy will not be allowed when cheering or

practicing.

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B. Refusing to participate in any cheerleading activity will result in

immediate dismissal from the squad.

C. Cheerleaders may be suspended or dismissed for failure to abide by the

terms of the cheerleading contract.

D. Cheerleaders will be given demerits for smoking, drinking alcoholic

beverages, or using illegal drugs at any time.

E. Cheerleaders may be dismissed for truancy or any major disciplinary

infractions listed in the Student Code of Conduct of the Pottsboro ISD.

F. Other improper conduct, determined by the sponsor and principal, could

result in suspension or dismissal.

G. Suspension for improper conduct will be for a period of three school

weeks. A second occurrence of any improper conduct will result in

permanent removal from the squad.

H. The following could be considered improper conduct. The list is not

meant to be all inclusive:

1. Being at any gathering where alcohol is being consumed

by a minor.

2. Riding in a vehicle in which a minor is transporting

alcohol.

3. Using false identification.

4. Unexcused absences or excessive tardies.

5. Lying to school officials.

6. Public display of affection (example: “hickies”, etc)

7. Any illegal activity such as shoplifting.

8. Obscene language or gestures.

9. Rude, hateful conduct directed towards students, teachers,

fellow cheerleaders or staff.

10. Cheating.

11. Inappropriate content on social media

J. All University Interscholastic League (UIL) guidelines will be followed.

A six weeks grade below 70 will result in a suspension from all activities

for the given period of time as defined by the “No Pass/No Play”

guidelines.

K. Summer practices and after-school practices are required and no excuses

will be made for absences. Cheerleaders must not allow work or social

lives to interfere with their duties.

L. A cheerleader is to behave in a manner that reflects positively on the

squad and Pottsboro ISD at all times. It must be remembered that squad

members can be identified even out of uniform. Members found to exhibit

behavior not in keeping with squad guidelines are subject to removal from

the squad if they fail to correct their behavior after one warning from the

sponsor. Examples of unacceptable behavior include malicious gossip,

causing disagreements, failing to respond to requests from the coach, etc.

Rumors are not considered fact; however, if a cheerleader’s name is

reported frequently and regularly, it will be considered worthy of

investigation. If the sponsor and principal believe that the cheerleader has

been engaged in improper behavior, appropriate discipline will follow.

ARTICLE XVI – COACH DUTIES

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The cheerleader coach is selected by the principal and considered the leader of the

cheerleading squad. All decisions made by the coach are in the best interest of the

squad and should be considered final. Any suggestions are welcome with the

understanding that the coach will use that information to make their own

decisions. Squad members who are having difficulties in school work, problems

with other squad members, or any other problems should immediately discuss the

matter with the coach. The coach will offer advice and help in seeking the

resources needed to make the squad a success.

RESPONSIBILITIES INCLUDE BUT ARE NOT LIMITED TO:

A. Will encourage attendance at a bus-driving school, maintain a current bus

driving certificate and have CDL license. Must be in compliance with

District Transportation Policy.

B. Responsible for organizing cheerleader election.

C. Nominates candidates for head cheerleader.

D. Makes decisions about absences and member removal.

E. Arranges all transportation according to travel guidelines, and completes

all required PISD paperwork.

F. Scheduling and posting of all practice times.

G. Assigns duties for all activities.

H. Screens and has veto power on all ideas, cheers, stunts, skits, signs, etc.

I. Responsible for supervision of all items ordered and for collection of

money. The sponsor shall get approval for all fundraisers.

J. The coach will be in attendance for:

1. Summer Camp

2. Tryouts

3. Practice Sessions

4. All functions that the cheerleaders are responsible for

attending.

K. The coach is responsible for collecting all cheerleading deposits, issuing

and collecting school purchased equipment and uniforms. The coach will

examine the condition of the uniforms and determine the amount, if any,

that will be returned to the cheerleader. Cheerleader must pay for any and

all damages.

L. Coach will assign demerits for constitution infractions.

M. Recommend to the administration if a cheerleader is to be suspended or

dismissed from the squad.

N. Responsible for informing all cheerleaders of changes in schedule,

upcoming events, etc.

O. Shall designate the area in which cheerleaders shall stand at basketball

games.

P. The building principal shall have the final say in all cheerleading

activities.

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ARTICLE XVII – HEAD CHEERLEADER

(Middle School)

The captain shall be nominated by the coach.

(High School)

The co-captains will be selected by the following process.

A. One will be nominated by the coach.

B. The other will be voted upon by the squad.

Each young lady that wants to be a co-captain must write a two page paper and

get it turned in by the deadline. Late papers will disqualify them. The paper must

include the following: define what they think a leader should be, why they want to

be a co-captain, and why they would be a good co-captain.

Head Cheerleader Duties:

A. Set a good example for squad to follow.

B. Plan pep rallies with the help of the squad and approval of the sponsor.

C. Be responsible for cheer and chant list at games.

D. Take charge of all practices, teaching yells, pompom routines, dance

routines, and stunts. (High school only)

E. Assist sponsor as needed.

F. Work with coach on all major decisions.

G. Responsible for setting up a schedule for the completion of signs and

posters. (High school only)

H. If the head cheerleader fails to abide by any of the above rules, the coach

may appoint a new head cheerleader.

I. Show no partiality toward other members of the squad.

J. Be a leader at all games and events.

ARTICLE XVIII – FINANCIAL RESPONSIBILITIES

Prior to try-outs parent must attend a general meeting (or visit individually with

cheerleader sponsor) which will outline cheerleading duties and responsibilities.

The parent must sign a sheet accepting financial responsibility for cheerleading

expenses.

Financial Responsibilities:

A. Purchase shoes, socks, briefs, tights/wind pants, pompoms. (Any

personal items which cannot be reused.)

B. Uniform cleaning at year end (uniform must be turned in along with

professional cleaning receipt.)

C. Camp clothes that have been approved by the coach.

D. Summer camp.

- 10 -

Cheerleaders will be given the opportunity to participate in a fundraiser after

tryouts to help pay for their personal expenses. All other fundraisers are at the

discretion of the coach/administration to benefit the team. The cheerleading

squad will have all fundraising approved by administration.

ARTICLE XIX—COMPETITIONS (High School Only)

The University Interscholastic League has approved a pilot program for a Spirit

Championship in 2016. This contest is to reward the cheerleaders for their efforts in

supporting all of the school teams and to stress safety and education.

The high school cheerleaders will be expected to represent their school in this

competition to be held on January 13th and 14th.

ARTICLE XX – DEMERITS

Deduction System

A. PRACTICE

1. Cheerleaders (CL) must wear matching

workout clothing when practice begins.

Camp wear

2 pt. deduction

2. Hair must be up and secure. 2 pt. deduction

3. No jewelry during practices. 2 pt. deduction

4. No chewing gum. 2 pt. deduction

5. No cursing/arguing with anyone 5 pt. deduction

6. CL may be no more than 5 minutes late

to practice

2 pt. deduction

7. CL will not leave practice or the practice

are without permission

2 pt. deduction

8. CL will attend all practices. Any

absence must be cleared by the coach

prior to the practice. Excused: personal

illness, death in family, illness in family

that requires out of town travel, funeral,

mandatory court appearance, and

religious holidays. Unexcused:

Work/vacation, appointments, non-uil

involvement (All-Stars, etc…)

Excused w/o prior notice will

be benched ½ game.

Exception:: death in family

Unexcused: Benched 1 game

9. CL cannot miss the last practice before a

game.

Benched 1 game

10. CL will attend all summer practices Benched ½ game per miss

11. No cell phone use unless given

permission by the coach

2 pt. deduction

B. GAMES/PEP RALLIES/ALL CHEERLEADER

ACTIVITIES

1. CL must be in correct/complete 3 pt deduction

- 11 -

uniform/dress up day attire at school on

game/pep rally days. Only designated

sweats/sweater may be worn with

uniform or spirit attire.

2. Hair will be up and secure as per coach 2 pt. deduction

3. No jewelry during performances, games

or pep rallies stud earrings only

2 pt. deduction

4. No chewing gum 2 pt. deduction

5. No cursing/arguing

5 pt. deduction

6. No cell phone use unless given

permission by the coach

2 pt. deduction

7. No colored nail polish (clear only) 3 pt. deduction

8. CL will maintain proper sideline

behavior at all times

a. NO excessive talking among

CL’s

b. No talking to people in the

crowd

c. Pay attention to the game/pep

rally

d. Stand in correct

formation/stance

e. Cheer/spirit, jump and tumble

the entire game or pep-rally

f. Only one person out of

formation at a time for drinks

g. No taunting the other team

h. CL will show respect during

the National Anthem and both

school songs.

2 pt. deduction

9. All CL will stay to clean up after each

game/pep rally and will be dismissed by

the coach

2 pt. deduction

10. CL will arrive on time and in correct

uniform at the designated meeting area

and will remain for the duration of the

game.

a. 30 minutes prior to

game

b. 15 minutes prior to

bus departure

c. If a CL misses the

bus he/she will not

be allowed to cheer

at the game.

5 pt. deduction

11. CL will be back on the field/court ready

to cheer at the designated time as

determined by the coach.

Benched 3rd quarter

12. CL will stay on the field/court for the 3 pt. deduction

- 12 -

entire game/pep rally.

13. CL will attend all games, pep rallies,

meeting, functions and activities. Any

absence must be cleared by the coach

prior to practice. Excused: Illness/doctor

permit, death in family, Unexcused:

Work/vacation, appointments, non-UIL

involvement (All-Stars, etc…) Note: An

absence from school does not excuse the

CL from the responsibility of calling the

coach.

Excused w/o prior notice will

be ½ game/pep-rally.

Exception: Death in the

family.

Unexcused will be benched

for 1 game.

14. CL acting in an unsafe manner as

determined by sponsor.

First offense: 5 pt. deduction

Second offense: Benched one

game

Third offense: Benched 2

games and principal/coach

review with possible dismissal

from the squad.

15. Leaving a cheerleading event early will

result in a benching equal to the time

missed.

C. SUMMER CAMP

1. Summer camp is mandatory

2. CL will be on time to all camp activities 5 pt. deduction

3. No cell phone use during camp classes

unless given permission by the coach

2 pt. deduction

4. A CL may not leave the campus with

anyone at any time unless approved by

the coach.

Sent home, and possible

squad dismissal

5. CL may not talk to family/friends when

engaged in a squad activity. Absolutely

no public display of affection.

5 pt. deduction

6. CL will respond to coach’s directions.

No disrespect will be tolerated.

10 pt. deduction

7. CL will follow all NCA/UCA or other

professional cheerleading association &

university camp rules and respect all staff

members.

10 pt. deduction

8. CL will respect each other and all other

squad members. No taunting/arguments

or cursing will be tolerated.

5 pt. deduction

9. Absolutely no smoking, drinking or

illegal substances will be tolerated.

Sent home, reported to the

principal and possible

dismissal from the squad.

D.UNIFORM GUIDELINES

1. CL will not wear uniform to a non-CL

function. (Eating after a game may be

approved by the coach as an exception to

this guideline.)

Benched 1 or more games or

dismissed from the squad.

2. CL will not lend out uniforms, sweats, 5 pt. deduction

- 13 -

letter jackets, etc. to someone who is not

a cheerleader.

3. CL are responsible for damage to or loss

of any part of uniform

Replacement of uniform or

cost to repair

E. GENERAL

1. CL hair will be a natural color Benched until returned to a

natural color

2. No visible tattoos, piercings or spacers Benched until no longer

visible

3. CL will not leave food, trash or mess in

the practice areas or performance areas

2 pt. deduction

4. CL will not participate in any public

display of affection during school, at

school activities or while wearing the CL

uniform

5 pt. deduction /office referral

5. CL will follow (not agree with) the head

CL’s instructions at all times at CL

activities.

Benched One Quarter

6. CL will respect/respond to coaches at all

times. Rudeness/insubordination will not

be tolerated.

Benched one game

7. CL will respect all teacher/staff members

at all times.

Benched one game.

8. CL placed in DMC 5 pt. deduction

9. CL placed in AEP Removal from the squad

10. CL receiving a failing grade for any class 3-6 week suspension based on

UIL guidelines

11. Any proof of inappropriate activity/

postings on social media

5 pt. deduction

NOTES

1. After a 15-point deduction, the CL will be benched for one event. If he/she

accumulates 25 points, he/she will be benched for three events. For each

additional five points accumulated after the 25, the cheerleader will be benched

for one event.

2. Accumulation of three or more benching’s may result in a principal/coach review

which could result in removal from the squad.

3. Injuries: If an injury occurs that keeps the student out of 2 practices, a note from

the student’s parent or doctor stating the reason will be required. If the injury

restricts the student from three or more practices, a doctor’s note will be required.

This note should state the nature of the injury, the length of time of the restriction,

the specific task the student cannot perform, and any special instructions. Lack of

participation will be categorized as missing practice if there is no note.

4. Any coach and principal review of student’s actions may result in dismissal from

the squad.

5. Guidelines: these are general rules and guidelines for al PISD cheerleaders.

Failure to comply may at times require judgment calls to be made. These

decisions will be left up to the coaches.

- 14 -

ARTICLE XXI– LETTER JACKETS AND LETTERS

Letter jackets can be earned by serving as a varsity cheerleader for one full year

provided no previous letter jacket has been awarded. The final decision on

awarding a letter jacket and/or letter will be made by the coach. Demerits and

tryouts for top cheerleader awards at camp will be considered.

==============================================================

I understand and will abide by the aforementioned demerit system.

___________________________________ __________________________

Cheerleader Signature Date

___________________________________ ___________________________

Parent/Guardian Signature Date

- 15 -

ACKNOWLEDGEMENT OF HANDBOOK INFORMATION

I have read the Pottsboro High/Jr. High School Cheerleading Handbook. I understand

that it contains policies that will be followed. Failure to follow the policies will result in

dismissal from the squad. My signature indicates that I agree to support the school and

coach in enforcing all policies. Furthermore, I understand the financial obligation for my

child to participate and I understand that all fees have to be paid by the deadline in order

for my child to remain on the squad.

PARENT SIGNATURE DATE

PARTICIPANT SIGNATURE DATE

- 16 -

POTTSBORO HIGH SCHOOL/JUNIOR HIGH

CHEERLEADING/MASCOT

APPLICATION/MEDICAL RELEASE

PERSONAL INFORMATION

NAME

LAST FIRST MIDDLE

ADDRESS CITY ZIP CODE

CELL PHONE ____________________

BIRTHDATE GRADE LEVEL

CANDIDATE FOR: CHEERLEADER MASCOT

PARENT(S)/GUARDIAN’S NAME PHONE (CELL)

EMPLOYER WORK NUMBER

MEDICAL INFORMATION AND RELEASE

DOCTOR DOCTOR’S NUMBER

DENTIST DENTIST’S NUMBER

EMERGENCY CONTACT/RELATIONSHIP PHONE

INSURANCE COMPANY PHONE # POLICY #

Are you allergic to any medications?__ ___ If so, what medication?

Are you currently taking medications? If so, for what?

I certify that is physically capable and able to fulfill requirements

to try-out/participate as a cheerleader/mascot. I understand that this form legally releases

all obligations and responsibilities for the medical treatment of my child in the event of

illness or injury during any squad related activity. If there is any physical or medical

reason why they should not participate fully, the school requires a doctor’s release.

Furthermore, the school is not liable for any injury incurred during workshops/try-outs or

practice/performances. In the event of an emergency, I grant my permission to the school

and it employees to take whatever action necessary. In the event that I cannot be reached,

I hereby authorize the school and/or its employees to give consent for my child

to receive medical treatment.

I give the coach authorization to give my son/daughter medication while attending practice/games

or events. Example—Tylenol, muscle rub, Neosporin, etc…

PARENT SIGNATURE DATE