Checklist:

Completed and signed application

Signed liability waiver (parents signature if under 18 years)
Front and back copy of health insurance card
Copy of Current Physical
Copy of Roadrunner Card, Acceptance Letter or written letter explaining intent to apply
$25 registration fee (cash only)
Name: __________________________
DS ID#_________________
Major: __________________________
G.P.A. _________________
Classification for fall: _______________
D.O.B._________________

Home Phone: _____________________

Cell ___________________

Address: __________________________________________
__________________________________________________________
Parents names: ___________________________________________
Parents address: ____________________________________________
___________________________________________________________
Parents phone: ______________________________________________

E-mail: ____________________________________________________
Shirt size:

Shorts size:

M
M

L
L

XL
XL

Shoe size: _____________

Height: _____________

Weight: _____________

How did you hear about Cheerleading Tryouts?

(Please choose one)
Friend Website

DS student

High School

Clinic

Facebook

Other__________________

HAVE YOU APPLIED TO DALTON STATE?

HAVE YOU BEEN ACCEPTED TO DALTON STATE?

SCHOOL CURRENTLY ATTENDING?

LIST PAST CHEER EXPERIENCE:

HIGH SCHOOL: __________________________________________________________
COLLEGE: __________________________________________________________
ALL STAR: __________________________________________________________

TUMBLING SKILLS/EXPERIENCE:
Standing:
Running:

STUNT:
Position:
Stunting Skills:

WE WANT TO GET TO KNOW YOU

WHAT MOTIVATED YOU TO TRY-OUT FOR DSC CHEERLEADING?

HOW DO YOU SPEND YOUR LEISURE TIME?

LIST CLUBS/ACTIVITIES IN WHICH YOU PARTICIPATE:

PERSONAL SKILLS THAT MAY CONTRIBUTE YOUR SUCCESS AS A CHEERLEADER:

WHAT ARE YOUR CAREER OBJECTIVES?

THIS IS THE FOUNDING YEAR OF CHEERLEADING AT DALTON STATE. WHAT DO YOU BELIEVE TO BE THE
MOST IMPORTANT TRADITION THAT SHOULD BE ESTABLISHED IN CHEERLEADING THIS FIRST YEAR?

Dalton State
Cheerleading
Statement of Understanding
I hereby certify that I fully understand the following:
1. Cheerleading involves a variety of gymnastics, motions, partner stunts, rotations and heights;
therefore, participation in cheerleading involves some amount of danger of personal injury. I
totally assume the risks involved by participating in this cheerleading clinic. I further realize
that improper conduct of cheerleading activity could result in catastrophic injury, paralysis or
even death.
2. I hereby certify that I have read, am thoroughly familiar with, and will carefully
abide by the American Association for Cheerleading Coaches and Advisors (AACCA)
guidelines for safety in college cheerleading (THIS WILL BE POSTED IN THE FACILITY
WHERE EVENT IS HELD).
3. I further agree to hold harmless Dalton State and the coaches, athletics, officers, directors,
staff, and cheerleading officials for any injury which I may incur by being a participant in the
cheerleading event.
Medical Insurance Company and Policy Number:
____________________________________
____________________________________
STATEMENT: I have read carefully this memorandum, and I understand and accept the
information and requirements contained in it.
Signature _________________________ Date ____________________

If under the age of eighteen years old a parent or guardians signature is required.
Signature _________________________ Date______________________