high school/middle school cheerleader constitution … · high school/middle school cheerleader...
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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.
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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
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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
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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
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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.
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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
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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
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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