High School Spirit Squad Tryout Packet 2021-2022 - Kearney Junior ...
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2021-2022
High School Spirit Squad
Tryout PacketDear Spirit Squad Candidates, Parents and/or Guardians,
Thank you for your interest in tryouts for the 2021-2022 Kearney High School Spirit
Squad. We believe that the spirit squad is a rewarding and exciting athletic activity that teaches
teamwork, dedication, sportsmanship, leadership, school spirit, and hard work.
Selection as a Kearney High School spirit squad team member is both an honor and a
privilege. As a KHS spirit squad member you will have an important role as a representative of
our school and will be expected to follow the KHS Student Handbook and Student
Activities/Athletic Handbook Code of Conduct and the guidelines set by MSHSAA and
MCCA/NFHS at all times, both on and off campus. When considering tryouts for our year long
spirit squad program, please carefully consider the time and commitment this sport will require
from both the athlete and parents. We typically operate 11 months per year between April -
March including the summer months. KHS Spirit Squad members are allowed to participate in
another KHS Athletic team during the fall and winter seasons. The athlete must declare their
sport priority and complete a schedule to be approved by both the spirit squad coach and
dual-sport coach. Your commitment will require active participation in, before and/or after
school practices, occasional weekend practices, pep rallies, fundraisers, community events,
squad bonding, and weekly games (football and basketball). Coaches may elect to participate in
1-2 competitions in the 2021-2022 school year.
Due to the fact that the spirit squad is a team sport; one person’s inability to follow
through on their commitment affects the entire squad. Members are expected to fulfill
obligations until the last scheduled activity. Each member is assured a position on the squad for
a single school year. Although placement on Varsity or JV is determined by your coaches based
on effort, attitude and attendance on a weekly basis. If a squad member is completely
removed for any reason (either by the athletes’ choice or by the coach and/or Athletic Director)
from any assigned squad, they are not eligible to rejoin/tryout for the spirit squad for 365 days
from the date of removal.
In addition to the time commitment, you will need to take into consideration your
academic requirements and financial responsibilities which will be covered in depth at the Post
Tryout Parent/Guardian meeting. Fundraising opportunities will be available to student-athletes
who make the squads, and to assist purchasing uniform pieces if needed.
Spirit Squad Coaches:
Varsity Coach- Anna Hewitt- hewitta@ksdr1.net
JV Coach- Shelby Dier- Diers@ksdr1.net
Assistant Coach- Kim Roth- Rothk@ksdr1.netIn order to participate in spirit squad tryouts, the athlete is required to
Pre-Register by Tuesday, April 27th:
Step #1- Athlete needs to complete the Cheer Contact Form- Spirit Tryouts
❏ Google Form:https://bit.ly/CheerContactInfo
Step #2- Athlete needs to make sure their physical is up to date
❏ MSHSAA Annual Pre-Participation Documents (3 pages- Due from each athlete
by Tuesday, April 27th)
❏ PDF: Download, print and complete:
https://drive.google.com/file/d/1cy_NVJDGMPdn19jbVS0nzWEwE0sSsZZ7/view?usp=sharing
❏ NEW 2 Year Sports Physical (form linked below)
❏ https://drive.google.com/open?id=1EpFD5RlqWN0JPl5GiL_OsmsOylx5eypV
❏ Athletes must have a MSHSAA sports physical dated NO EARLIER than
Aug. 9th, 2019 and signed by a physician. Physicals are current for 2
years from the day you receive them, but we require them to be current
for the entire summer. NO EXCEPTIONS may be made for this rule.
The current MSHSAA physical form must be on file with the athletic
office by Tuesday, April 27th if you are going to try out.
❏ If you are a returning cheerleader, I have already emailed you separately
if your physical will expire before the Aug 9th cut off date.
❏ *If you do not know when your last physical date was, please contact
Brighton Terwilleger (email terwillegerb@ksdr1.net in the Athletic Office to
check your current expiration date)
Step #3- Athlete needs to complete the form “KHS Spirit Squad Tryout Agreement. Due
from each athlete by Tuesday, April 27th to be eligible to tryout
❏ https://drive.google.com/file/d/1-Sk3Al7l-UxJR56mBFb9L3IgoPoz7j2P/view?usp=sharingStep #4- KHS Spirit Squad Financial Responsibility Agreement: (Due by April 27th)
PDF: Download, print and complete: Due from each athlete by Tuesday, April 27th to be
eligible to tryout
https://drive.google.com/file/d/1-VG6vADPwXsHZvwQ-3gEDqDxthfeQjQY/view?usp=sharing
Pre-Registration Event:Spirit Squad Physical and Paperwork Turn In
● Tuesday, April 27th- Please sign up for a time slot.
● Schedule your time here:
https://www.signupgenius.com/go/60B0A49A8A62DA5F85-spirit3
● We will be meeting in Coach Hewitt’s classroom (FACS room at the Jr High- Room
C101) for paperwork turn in on Tuesday, April 27th
● Athletes need to maintain social distancing and wear a mask while on school property.
Please make sure to leave the school property once you have turned in your papers and
they have been checked by a coach.
● If you are running late or unable to make your assigned time, please sign up for one of
the remaining open slots.
● If a time on this day does not work, please turn in all papers to KHS main office (or to
Coach Hewitt) no later than Monday, April 26th. If you do not have a printer at home,
there will be a tray of new packets for you to pick up. The office is open M-F, 7am to
3pm.
● *Returning Cheerleaders- Please bring Purple Uniform to check in if you have not done
so to be eligible for tryouts!
Spirit Squad Tryout Clinics
May 3rd to 5th (3:30 to 5:00pm)
● Tryout material will be taught live on Monday, Tuesday and Wednesday (May 3rd, 4th
and 5th) during our Cheer tryout clinics. Pre-registration is required to participate in the
clinics. Registration paperwork is due no later than April 27th (please see the above
requirements)
● Athletes need to maintain social distancing and wear a mask while on school property.
Please make sure to leave the school property once clinics have ended each day.
● Videos and practice material will be released throughout the week to assist in at-home
practice
○ Please download and join our squad on the Band App
■ https://band.us/n/a6a757JcP7j2V○ All example tryout videos will be released on the Band App. If you are unable to
download the app, please email Coach Hewitt at hewitta@ksdr1.net
What to expect at KHS tryouts:
● KHS Spirit Squad Tryouts: Thursday, May 6th beginning at 3:30pm.
○ Please choose a time slot for your tryout:
https://www.signupgenius.com/go/60B0A49A8A62DA5F85-spirit4
Following social distance guidelines, each tryout group will be assigned 20 minutes at KHS
-First 10 minutes in Gym 2 to warm up on the practice mat with your partner.
-Last 10 minutes in Gym 1 to perform your tryout with your partner
Tryouts will be recorded and sent to Varsity Judges for feedback.
Tryout Guidelines:
-Arrive no earlier than 30 minutes before your assigned time slot to stretch and warm up in Gym
2. You may not step onto the warm up mat before your scheduled time. There will be other
mats provided in the gym, but please leave the warm up mat for those who are on deck to try
out next.
-Only athletes trying out for cheer are allowed to enter the school building.
-Exit by Gym 1 once you are finished. Once you finish your tryout, you must immediately leave
school property
**Late arrivals will not be able to try out during their designated time slot. If you arrive late,
please schedule a second appointment later in the day in one of the remaining available time
slots.
We are thrilled that you are considering trying out for the 2021-2022 KHS Spirit Squad! All
athletes trying out for the spirit squad will be required to perform a spirited entrance, jumps,
dance, chant, cheer, back handsprings and tumbling passes. (optional) Tryouts will be
recorded and sent to highly qualified judges. A judging panel and coaches will score each
athlete on motions, voice, coordination, jumps, dance ability, and spirit. Members will be
considered based upon a combined score from tryouts and coaches scores. Coaches will also
take into consideration building a squad utilizing all positions of stunts. *Coaches discretion
Tumbling skills are a part of the score for the KHS Spirit Squad. Points will be awarded for the
tumbling skills of a back handspring and more advanced tumbling moves. We do encourage
you to begin working on flexibility, conditioning and jumps prior to tryouts.
Attire for Tryouts: Plain white t-shirts, black shorts and tennis shoes. (NO spandex, sports
bras, or tight fitting clothing can be worn for tryouts.) You must adhere to the school dress code
policy. Please refrain from bare midriffs, spaghetti straps, etc. Wear athletic shoes in which you
can easily jump, tumble, and dance. Gum or jewelry is not allowed during tryouts or clinic. We
will check to ensure that all piercings have been removed per MSHSAA requirements. Hair
should be pulled back in a ponytail. Nails should be clear of all polish and no longer than yourfingertips. (They will remain this length and clear of polish for the entire season for stunting,
tumbling and MSHSAA safety purposes). We have attached a copy of the tryout score of the
athlete so you may begin preparing.
Please bring a water bottle (as the water fountains will not be available at this time), your school
spirit and a willingness to try! First and foremost we are looking for coachable athletes with
great attitudes to represent KHS! A copy of the judging sheet is provided for athletes to see
what will be expected from them on Thursday, May 6th.
We look forward to an exciting tryout process and wish each one of you the best of luck!
Announcement of Spirit Squads
Saturday, May 8th
Athletes only: please plan to meet with a coach on Saturday, May 8th. A sign up link is
attached to schedule your conference time.
https://www.signupgenius.com/go/60B0A49A8A62DA5F85-squad
Best of luck and please do not hesitate to contact us should you have any questions.
KHS Cheer Spring/Summer Calendar:
https://docs.google.com/spreadsheets/d/1vpGgNi8S8vyR_--0JfiI5A3lfU2V5j0MqQkCxwInvNU/e
dit?usp=sharingEXAMPLE: KHS Cheer 2021-2022
Candidate Number_________________ Judge Number ______________
1-Poor 2-Fair 3-Average 4-Excellent 5-Superior
Personal Appearance (15 points)
General Appearance (tidy attire, hair, etc) 1 2 3 4 5
Crowd Appeal- Eye Contact- Expressions 1 2 3 4 5
Overall Spirit 1 2 3 4 5
Total_______/15
Jumps (15 points)
Toe-Touch (height, form, timing, toes, arms) 1 2 3 4 5
Optional Jump (height, form, timing, toes, arms) 1 2 3 4 5
Double Toe Touch 1 2 3 4 5
Total________/15
Sideline(20 points)
Knowledge of sideline (memory, timing) 1 2 3 4 5
Technique-Precision (arms, motions, etc) 1 2 3 4 5
Voice Projection 1 2 3 4 5
Spirit-Expression-Confidence 1 2 3 4 5
Total________/20
Cheer-(20 points)
Knowledge of chant (memory, timing) 1 2 3 4 5
Technique-Precision (arms, motions, etc) 1 2 3 4 5
Voice Projection 1 2 3 4 5
Spirit-Expression-Confidence 1 2 3 4 5
Total________/20
Dance Routine (20 points)
Rhythm, timing, coordination 1 2 3 4 5
Precision (body placement, arms, legs, hands etc) 1 2 3 4 5
Overall Knowledge of routine (memory) 1 2 3 4 5
Showmanship (confidence, expression) 1 2 3 4 5
Total________/20
Tumbling Skills (20 points)
Standing Back Handspring 1 2 3 4 5
Roundoff BH Series or Roundoff Tuck 1 2 3 4 5
Roundoff BHS Tuck 1 2 3 4 5
Layout/ or Standing Tuck/Full 1 2 3 4 5
Total________/20
Total Overall:__________________/ 110To perform at Varsity Level Cheer Requirements:
● Run a mile in 9:15 or less
● Complete 45 Sit-ups in One minute
● Complete 25 Push-ups in a row (without stopping or pausing)
● Perform at level or above: Toe Touch, Front Hurdler, Side Hurdler, Double Toe
Touch
● Know how to execute: Jump approach and proper Landing
● SHARP motion technique and placement
● Consistently appropriate voice: volume and enthusiasm
● Regular attendance to practices
● Regular participation in stunting in the positions requested by your coach
● Perform stunts at a level 3 or higher in your assigned position with your group
● Regular attendance to fundraisers and camps
● Positive attitude towards peers and coaches
● GREAT enthusiasm for Kearney High School and activities!
● Standing Back Handspring or above (Preferred but not mandatory)
● Round-off Back Handspring or above (Preferred but not mandatory)
To perform at Junior Varsity Level Cheer Requirements:
● Run a mile in 10:25 or less
● Complete 40 Sit-ups in One Minute
● Complete 15 Push-ups in a row (without stopping or pausing)
● Know how to execute: Jump approach, Toe Touch, Front Hurdler, Side Hurdler,
Pike and Landing
● Coordination Tumbling: Ex. Round-off Toe Touch
● Know motion placement
● Regular attendance to Fundraisers and Camps
● Show Spirit for Colony High School!
● Positive attitude towards peers & coaches
Attention:
** Please note...We, the KHS cheer coaching staff (Coach Hewitt, Coach Roth and
Coach Dier), have the final say on team rosters throughout the season. No position is
final (in other words, always be working on your skills). Athletes and their positions
will be evaluated and changes will be made as necessary for the good of the team.
**You do NOT automatically make varsity if you have a back handspring and/or round
off back handspring. You must show and complete all other requirements listed
above in order to be part of this team.****You do NOT automatically make Varsity or JV if you were on the team last year. All
former squad members must tryout again and have the above requirements to make
either team. **Revised 6/2019
PRE-PARTICIPATION PHYSICAL EVALUATION
PHYSICAL EXAMINATION FORM – VALID FOR 2 YEARS
Name: Date of Birth:
Physician Reminders:
1. Consider additional questions on more-sensitive issues. Do you drink alcohol or use any other drugs?
Do you feel stressed out or under a lot of pressure? Have you ever taken anabolic steroids or used any other performance-enhancing
Do you ever feel sad, hopeless, depressed or anxious? supplement?
Do you feel safe at your home or residence? Have you ever taken any supplements to help you gain or lose weight or improve
Have you ever tried cigarettes, chewing tobacco, snuff or dip? your performance?
During the past 30 days, did you use chewing tobacco, snuff or dip? Do you wear a seat belt, use a helmet and use condoms?
2. Consider reviewing questions on cardiovascular symptoms (Questions 4-13 of History Form).
EXAMINATION
Height: Weight:
BP: / ( / ) Pulse: Vision: R 20/ L 20/ Corrected: ☐ Yes ☐ No
MEDICAL NORMAL ABNORMAL FINDINGS
Appearance
Marfan stigmata (kyphoscoliosis, high-arched palate, pectus
excavatum, arachnodactyly, hyperlaxity, myopia, mitral valve
prolapse (MVP) and aortic insufficiency)
Eyes, ears, nose and throat
Pupils equal
Hearing
Lymph Nodes
Heart*
Murmurs (auscultation standing, auscultation supine and +/-
Valsalva maneuver)
Lungs
Abdomen
Skin
Herpes simplex virus (HSV), lesions suggestive of methicillin-
resistant Staphylococcus aureus (MRSA) or tinea corporis
Neurological
MUSCULOSKELETAL NORMAL ABNORMAL FINDINGS
Neck
Back
Shoulder and arm
Elbow and forearm
Wrist, hand and fingers
Hip and thigh
Knee
Leg and ankle
Foot and toes
Functional
Double-leg squat test, single-leg squat test and box drop or
step drop test
* Consider electrocardiography (ECG), echocardiogram, referral to cardiology for abnormal cardiac history or examination findings, or a combination of those.
☐ Cleared for all sports without restriction for two (2) years.
☐ Cleared for all sports without restriction for two (2) years with recommendation for further evaluation or treatment for:
☐ Cleared for all sports without restriction for less than two (2) years. Specify reasons and duration of approval below:
☐ Not Cleared
☐ Pending further evaluation ☐ For any sports ☐ For certain sports (please list):
Reason:
Recommendations/Comments:
I have examined the above-named student and completed the pre-participation physical evaluation. The athlete does not present apparent clinical contraindications to practice
and participate in the sport(s) as outlined above. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. If
conditions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are
completely explained to the athlete (and parents/guardians).
Name of healthcare professional (type/print): Date of Issue:
Address: Phone:
Signature of healthcare professional (MD/DO/ARNP/PA/Chiropractor):
This physical is valid for a 2-year period unless otherwise noted by the physician in the “Recommendations” field listed above.Revised 6/2019
MEDICAL HISTORY
Note: Complete and sign this form (with your parents if younger than 18) before your appointment. The physician should keep a copy of this form in the chart for their records.
Note: An injury or medical condition results in a separate medical release.
Name: Date of Birth:
Date of examination:
Sex assigned at birth (F, M or intersex): How do you identify your gender? (F, M or other):
List past and current medical conditions:
Have you ever had surgery? If yes, list all past surgical procedures:
Medicines and supplements: List all current prescriptions, over-the-counter medicines and supplements (herbal and nutritional):
Do you have any allergies? If yes, please list all of your allergies (i.e., medicines, pollens, food, stinging insects):
PATIENT HEALTH QUESTIONNAIRE VERSION 4 (PHQ-4)
Over the last 2 weeks, how often have you been bothered by any of the following problems (circle response).
Not at All Several Days Over Half the Days Nearly Every Day
Feeling nervous, anxious or on edge: 0 1 2 3
Not being able to stop or control worrying: 0 1 2 3
Little interest or pleasure in doing things: 0 1 2 3
Feeling down, depressed or hopeless: 0 1 2 3
A sum of ≥3 is considered positive on either subscale (questions 1 and 2, or questions 3 and 4) for screening purposes.Revised 6/2019
Explain “Yes” answers at the end of this form. Circle questions if you don’t know the answer.
GENERAL QUESTIONS Yes No MEDICAL QUESTIONS Yes No
1. Do you have any concerns that you would like to discuss with 16. Do you cough, wheeze, or have difficulty breathing during or
your provider? after exercise?
2. Has a provider ever denied or restricted your participation in 17. Are you missing a kidney, an eye, a testicle (males), your
sports for any reason? spleen or any other organ?
3. Do you have any ongoing medical issues or recent illness? 18. Do you have groin or testicle pain or a painful bulge or hernia
in the groin area?
HEART HEALTH QUESTIONS ABOUT YOU Yes No
19. Do you have any recurring skin rashes or rashes that come
4. Have you ever passed out or nearly passed out during or and go, including herpes or methicillin-resistant
after exercise? Staphylococcus aureus (MRSA)?
5. Have you ever had discomfort, pain, tightness, or pressure in 20. Have you had a concussion or head injury that caused
your chest during exercise? confusion, a prolonged headache or memory problems?
6. Does your heart ever race or skip beats (irregular beats) 21. Have you ever had numbness, had tingling, had weakness in
during exercise? your arms or legs, or been unable to move your arms or legs
7. Has a doctor ever told you that you have any heart after being hit or falling?
problems? 22. Have you ever become ill while exercising in the heat?
8. Has a doctor ever ordered a test for your heart? (For 23. Do you, or does someone in your family, have sickle cell trait
example, electrocardiography (ECG) or echocardiography? or disease?
9. Do you get light-headed or feel shorter of breath than your 24. Have you ever had, or do you have, any problems with your
friends during exercise? eyes or vision?
10. Have you ever had a seizure? 25. Do you worry about your weight?
HEART HEALTH QUESTIONS ABOUT YOUR FAMILY Yes No 26. Are you trying to, or has anyone recommended, that you gain
or lose weight?
11. Has any family member or relative died of heart problems or 27. Are you on a special diet or do you avoid certain types of
had an unexpected or unexplained sudden death before age foods or food groups?
35 (including drowning or unexplained car crash)? 28. Have you ever had an eating disorder?
12. Does anyone in your family have a genetic heart problem
such as hypertrophic cardiomyopathy (HCM), Marfan FEMALES ONLY Yes No
syndrome, arrhythmogenic right ventricular cardiomyopathy 29. Have you ever had a menstrual period?
(ARVC), long QT syndrome (LQTS), short QT syndrome 30. How old were you when you had your first menstrual period?
(SQTS), Brugada syndrome or catecholaminergic 31. When was your most recent menstrual period?
polymorphic ventricular tachycardia (CPVT)? 32. How many periods have you had in the past 12 months?
13. Has anyone in your family had a pacemaker or an implanted
defibrillator before age 35?
BONE AND JOINT QUESTIONS Yes No
14. Have you ever had a stress fracture or an injury to a bone,
muscle, ligament, joint or tendon that caused you to miss a
practice or game?
15. Do you have a bone, muscle, ligament or joint injury that
bothers you?
IF “YES,” EXPLAIN ANSWERS HERE
I hereby state that, to the best of my knowledge, my answers to the questions on this form are complete and correct.
Signature of Athlete:
Signature of Parent(s) or Guardian:
Date:Revised 6/2019 MSHSAA PRE-PARTICIPATION DOCUMENTATION – ANNUAL REQUIREMENTS INTERIM MEDICAL HISTORY Note: Complete and sign this form (with your parents if younger than 18). Note: An injury or medical condition results in a separate medical release. Name: Date of Birth: Date: Sex assigned at birth (F, M or intersex): How do you identify your gender? (F, M or other): List past and current medical conditions: Have you had surgery since your last Pre-Participation Physical Examination (physical)? If yes, list those surgical procedures: Medicines and supplements: List all current prescriptions, over-the-counter medicines and supplements (herbal and nutritional): Do you have any allergies? If yes, please list all of your allergies (i.e., medicines, pollens, food, stinging insects): Have you been diagnosed with any medical or health condition since your last PPE (physical)? If yes, please describe: I hereby state that, to the best of my knowledge, my answers to the questions on this form are complete and correct. Signature of Athlete: Signature of Parent(s) or Guardian: Date:
PARENT PERMISSION (Authorization for Treatment, Release of Medical Information, and Insurance Information)
Informed Consent: By its nature, participation in interscholastic athletics includes risk of serious bodily injury and transmission of infectious disease
such as HIV and Hepatitis B. Although serious injuries are not common and the risk of HIV transmission is almost nonexistent in supervised school
athletic programs, it is impossible to eliminate all risk. Participants must obey all safety rules, report all physical and hygiene problems to their coaches,
follow a proper conditioning program, and inspect their own equipment daily. PARENTS, GUARDIANS, OR STUDENTS WHO MAY NOT WISH TO
ACCEPT RISK DESCRIBED IN THIS WARNING SHOULD NOT SIGN THIS FORM. STUDENTS MAY NOT PARTICIPATE IN MSHSAA-
SPONSORED SPORT WITHOUT THE STUDENT’S AND PARENT’S/GUARDIAN/S SIGNATURE.
I understand that in the case of injury or illness requiring transportation to a health care facility, a reasonable attempt will be made to contact the parent
or guardian in the case of the student-athlete being a minor, but that, if necessary, the student-athlete will be transported via ambulance to the nearest
hospital.
We hereby give our consent for the above student to represent his/her school in interscholastic athletics. We also give our consent for him/her to
accompany the team on trips and will not hold the school responsible in case of accident or injury whether it be en route to or from another school or
during practice or an interscholastic contest; and we hereby agree to hold the school district of which this school is a part and the MSHSAA, their
employees, agents, representatives, coaches, and volunteers harmless from any and all liability, actions, causes of action, debts, claims, or demands of
every kind and nature whatsoever which may arise by or in connection with participation by my child/ward in any activities related to the interscholastic
program of his/her school.
In the event of an emergency or when the Parent(s) or Guardian is unable to directly supervise health care services needed by the student for injuries or
illnesses sustained at any athletic practice, conditioning exercise or contest, I also give my consent to the rendering of necessary health care services
for the student by a qualified provider (QP) covering the athletic practice, conditioning exercise or contest, including an athletic trainer, physician,
physician assistant, nurse practitioner or other medically-trained professional licensed by the State of Missouri (or the state in which the student injury or
illness occurs) and who is acting in accordance with the scope of practice under their designated state license and any other requirement imposed by
state law. In emergency situations, the QP may also be a certified paramedic or emergency medical technician for the purpose of providing emergency
health care and transport. Health care services are defined as services including, but not limited to, evaluation, diagnosis, first aid, emergency care,
stabilization, treatment and referral. I further authorize the QP who provides such health care services to disclose such information about the student’s
injury or illness, diagnosis, care and treatment in the professional judgment of the QP to the student’s athletic director, coaches, school nurse and any
classroom teacher required to provide academic accommodation to assure the student’s recovery and safe return to activity. If the Parent(s) or Guardian
believes that the student is in need of further evaluation, treatment, rehabilitation or health care services for the injury or illness, the student may be
treated by the physician or provider of his or her choice.
To enable the MSHSAA to determine whether the herein named student is eligible to participate in interscholastic athletics in the MSHSAA member
school, I consent to the release of any and all portions of school record files to MSHSAA, beginning with seventh grade, of the herein named student,
specifically including, without limiting the generality of the foregoing, birth and age records, name and residence address of parent(s) or guardian(s),
residence address of the student, academic work completed, grades received, and attendance data.
We confirm that this application for the above student to represent his/her school in interscholastic athletics is made with the understanding that we have
studied and understand the eligibility standards that our son/daughter must meet to represent his/her school and that he/she has not violated any of
them. We also understand that if our son/daughter does not meet the citizenship standards set by the school or if he/she is ejected from an
interscholastic contest because of an unsportsmanlike act, it could result in him/her not being allowed to participate in the next contest or suspension
from the team either temporarily or permanently.
I consent to the MSHSAA’s use of the herein named student’s name, likeness, and athletic-related information in reports of contests, promotional
literature of the Association and other materials and releases related to interscholastic athletics.
We further state that we have completed that part of this certificate which requires us to list all previous injuries or additional conditions that are known to
us which may affect this athlete's performance or treatment and we certify that it is correct and complete.
The MSHSAA By-Laws provide that a student shall not be permitted to practice or compete for a school until it has verification that he/she has basic
health/accident insurance coverage, which includes athletics. Our son/daughter is covered by basic health/accident insurance for the current school
year as indicated below:
Name of Insurance Company: Policy Number:
Signature of Parent(s) or Guardian: Date:
Has this student incurred a medical condition since their last physical examination?
□ Yes □ NoSTUDENT AGREEMENT (Regarding Conditions for Participation)
This application to represent my school in interscholastic athletics is entirely voluntary on my part and is made with the understanding that I have studied
and understand the eligibility standards that I must meet to represent my school and that I have not violated any of them.
I have read, understand, and acknowledge receipt of the MSHSAA brochure entitled “How to Maintain and Protect Your High School Eligibility,” which
contains a summary of the eligibility rules of the MSHSAA. (I understand that a copy of the MSHSAA Handbook is on file with the principal and athletic
administrator and that I may review it in its entirety, if I so choose. All MSHSAA by-laws and regulations from the Handbook are also posted on the
MSHSAA website at www.mshsaa.org).
I understand that a MSHSAA member school must adhere to all rules and regulations that pertain to school-sponsored, interscholastic athletics
programs, and I acknowledge that local rules may be more stringent than MSHSAA rules.
I also understand that if I do not meet the citizenship standards set by the school or if I am ejected from an interscholastic contest because of an
unsportsmanlike act, it could result in me not being allowed to participate in the next contest or suspension from the team either temporarily or
permanently.
I understand that if I drop a class, take course work through Post -Secondary Enrollment Option, Credit Flexibility, or other educational options, this
action could affect compliance with MSHSAA academic standards and my eligibility.
I understand that participation in interscholastic athletics is a privilege and not a right. As a student athlete, I understand and accept the following
responsibilities:
I will respect the rights and beliefs of others and will treat others with courtesy and consideration.
I will be fully responsible for my own actions and the consequences of my actions.
I will respect the property of others.
I will respect and obey the rules of my school and laws of my community, state, and country.
I will show respect to those who are responsible for enforcing the rules of my school and the laws of my community, state, and country.
I have completed and/or verified that part of this certificate which requires me to list all previous injuries or additional conditions that are known to me
which may affect my performance in so representing my school, and I verify that it is correct and complete.
Signature of Athlete: Date:
Have you experienced a medical condition since your last physical examination?
□ Yes □ No
PARENT AND STUDENT SIGNATURE (Concussion Materials)
I accept responsibility for reporting all injuries and illnesses to my school and medical staff (athletic trainer/team physician) including any signs and
symptoms of a CONCUSSION. I have received and read the MSHSAA materials on Concussions, which includes information on the definition of a
concussion, symptoms of a concussion, what to do if I have a concussion and how to prevent a concussion. I will inform my school and athletic
trainer/team physician immediately if I experience any of these symptoms or if I witness a teammate with these symptoms.
Signature of Athlete: Date:
Signature of Parent(s) or Guardian: Date:
EMERGENCY CONTACT INFORMATION
Parent(s) or Guardian Address Phone Number
Name of Contact Relationship to Athlete Phone Number
Name of Contact Relationship to Athlete Phone NumberKearney High School
2021-2022 SPIRIT SQUAD AGREEMENT
For Athlete to Complete:
I (the athlete) have read the Kearney High School Spirit Squad Tryout Information for the
2021-2022 school year. I understand the tryout process, expectations of the athlete during
tryouts.
Athlete name___________________________________________________________
Athlete Phone ______________________ Athlete Email ________________________
Athlete signature______________________________ Date________________________
For Parent to Complete:
I (the guardian of the above athlete) have read the Kearney High School Tryout Information for
the 2021-2022 school year.
I do ______/do not ____give permission for the athlete to participate in the tryout process and
as a member of the 2021-2022 KHS Spirit Squad if the athlete is selected.
I do ______/do not ____give permission for the athlete to participate in the Band App and
Remind to keep in contact as a member of the 2021-2022 KHS Spirit Squad if the athlete is
selected.
I do _____/ do not ____ give the spirit squad coaches permission to access my athlete’s current
grades in order to determine eligibility for participation in the 2021-2022 spirit squad.
___Yes / ___No- My athlete has a 504/IEP that I want coaches to be aware of.
Parent Name(s)____________________________________________________
Best Phone Number: _______________________________________________
Parent Email (s) ___________________________________________________
Parent signature________________________________Date______________________
● The coaches have discretion to make the final decision based upon athlete
participation in tryouts.
● Please remember we are building a team, each athlete will bring unique strengths
to the squad.Kearney Cheer Payment Information
2020-2021 Athlete Name:
Estimated Expenses for the 2021-2022 school year.
Use this work sheet to estimate your athletes' total expenses. Total your
athlete's expenses at the bottom of the chart. Please sign and return on
April 27th with the rest of your paperwork
2021-2022
Grade Level ________
Categories: Returning New Returning New
Cheerleader Cheerleader Cheerleader Cheerleader
Estimate Estimate Estimate Estimate
(Varsity) (Varsity) (JV) (JV)
UCA Camp 1) Circle which category
*Strongly your athlete falls into.
Encouraged
-July 19, 20,
21 at KHS- $236 $236 $236 $236
Camp Shirts 2) If you decide to add on
*Will need any item, or remove an
your own item, just write it in/cross
black shorts, it off in the provided
black column boxes.
leggings and
all black
mask $45 $45 $45 $45
Black Skort 3) Complete the sizes
(Varsity requests below
Brand) $25 $25
4) Total your order at the
Camp Meals $60 $60 $60 $60 bottom of this chart
5) Have a parent read
and sign the financial
Camp agreement at the bottom
Overnight of the page. Bring this
Bonding document with you to
(July 20-21) $45 $45 $45 $45 turn in on April 27th
Uniform
(Black
Uniform-
yours to
keep)
Includes: 2
tops, Mid and
skirt $291 $291
Uniform
(Purple
Uniform-
checked out
for season) $0 $0 $0 $0White Mid for
Purple Athlete complete: Sizes
Uniform $22 $22 needed
Warm-Up
Pkg
*(Pull-Over
and Joggers) $146 $146 T-Shirt: _______
Warm-Up
Jacket
Replacement
*Add $94 Short:_______
Warm-Up
Jogger
Replacement
*Add $52 Shoes: ______
Shoes (Same
as last year-
will need to
replace if not
in great
shape $79 $79 Fitted Shirt/Tank: ____
Metallic Mix
Poms $42 $42 Fitted Capri ____
Rebel Bling
Backpack $108 $108
Pink Ribbon
and Poms $42 $42
Game-Day
Bow $10 $10
To be filled in later by
Rain Weather coach-
Gear $26 $26 Uniform size:
Cold Weather
Gear *(Will skirt _________
need to skort: _________
provide your Mid: ________
own black
gloves for
games) $21 $21
Briefs/Spank
s *Add $25 if Measurements:
you purchase Arms length_____
from KHS Inseam _____
Shipping
Costs $25 $25 $25 $25 Waist _______
Competition Bust ________
Fees $35 $35 $0 $0 Torso Length _______
Estimated
Total $446 $1,258 $411 $1,222After totaling your
estimated expenses
Updated with all of your
Estimated additional items added
Total or taken away- write
your new total in the
box to the left
*Expected Payment Due Dates:
-Payment #1-Thursday, May 13th- Due for all cheerleaders $300
-Payment #2- Tuesday, June 22nd- Due for all cheerleaders $300 (or balance if less)***
-Payment #3- Tuesday, July 13th- Due for all cheerleaders $300 (or balance if less)***
-Payment #4- Tuesday, August 17th- Remainder Due for all cheerleaders ***
*****For the 2021-2022 season- an athlete must pay their account in FULL****
before they are allowed to perform (Season items will not be released
to cheerleader until items have been paid for in full)
Athlete Name ____________________________ Parent Name_____________________________________
I have read and understand the above expenses are 100% my responsibility to pay if placed on the 2021-2022
cheer squad. The KHS cheer squad will participate in 1 summer fundraiser, where my athlete can earn financial
help toward the end balance due. I understand my athlete will not cheer or receive items until balance is paid
in full. This does not take away from a current payment due. If my athlete is not participating in practices and
games due to non-payment, his/her spot will not be gauranteed on the squad of choice upon returning.
Athlete Signature: _______________________________________
Date ________________
Parent Signature: ______________________________________
Date ________________Kearney Bulldog Cheer
2021-2022 Cheer- Spring/Summer Tentative Schedule
*Subject to change as needed- this is not the final schedule*
April 2021 April
Su M Tu W Th F Sa 1 Thursday April Fool's Day
1 2 3 22 Thursday Earth Day
4 5 6 7 8 9 10 19 Monday Tryout Parent/Athlete Meeting- More info TBD
11 12 13 14 15 16 17 12 Monday Tryout Packets Available in the office at KHS and KJH
27 Tuesday All Paperwork/Physicals Due back to Coach Hewitt- KJH Room C102
18 19 20 21 22 23 24 *Drop Off Box Located in KJH and KHS Offices by 2:30 pm
25 26 27 28 29 30
May 2021 May
Su M Tu W Th F Sa 9 Sunday Mother's Day
1 31 Monday Memorial Day
2 3 4 5 6 7 8 3 Monday Tryout Clinic- Mandatory to tryout-KHS Gym 2- 3:30 to 5:00pm
9 10 11 12 13 14 15 4 Tuesday Tryout Clinic- Mandatory to tryout-KHS Gym 2- 3:30 to 5:00pm
16 17 18 19 20 21 22 5 Wednesday Tryout Clinic- Mandatory to tryout-KHS Gym 2- 3:30 to 5:00pm
KHS Cheer Tryouts 2021-2022 Seasons- Location KHS Gym 1 & Gym 2-
23 24 25 26 27 28 29 6 Thursday 3:00pm to 8:00pm- By appointment only
30 31 8 Saturday Results meeting with coach- Location/Time TBD- By appointment only
Varsity Fittings at 2:45pm in Coach Hewitt's room
13 Thursday ***Deposit #1 Due for all cheerleaders $300***
Practice 2:45 to 4:30pm/ Cookie Dough Fundraiser Begins @ 4pm
17 Monday Location- KJH Gym 2
18 Tuesday Practice 2:45 to 4:30 pm- Location KJH Gym 2
Practice 2:45 to 4:30pm/ Cookie Dough- Check In #1 @ 4pm
21 Friday Location- KJH- Gym 2
Practice 2:45 to 4:30pm/ Cookie Dough Check In #2 @ 4pm
24 Monday Location- KJH Gym 2
Practice 2:45 to 4:30pm/ Cookie Dough Final Turn In @ 4pm
25 Tuesday Location- KJH Gym 2
June 2021 June
Su M Tu W Th F Sa 14 Monday Flag Day
1 2 3 4 5 20 Sunday Father's Day
6 7 8 9 10 11 12 JUNE Morning Pratices - Usually 8 to 10 am ish- T/W/Th
13 14 15 16 17 18 19 JUNE Weights typically follows practices- exact times TBD
***Deposit #2 Due for all cheerleaders $300 (or balance if less)***
For the 2021-2022 season- an athlete must pay their account
20 21 22 23 24 25 26 22 Tuesday before items can be ordered.
27 28 29 30
July 2021 July
Su M Tu W Th F Sa 4 Sunday Independence day
1 2 3 JULY Activities Dead Week (Will not Practice July 2 to July 12)
4 5 6 7 8 9 10 JULY Morning Pratices - Usually 8 to 10 am ish- T/W/Th
11 12 13 14 15 16 17 JULY Weights typically follows practices- exact times TBD
00-049Calendar Template by Vertex42.com 00-049https://www.vertex42.com/calendars/school-calendar.html***Deposit #3 Due for all cheerleaders $300 (or balance if less)***
For the 2021-2022 season- an athlete must pay their account
18 19 20 21 22 23 24 13 Tuesday before items can be ordered.
25 26 27 28 29 30 31 19 Monday UCA Cheer Camp- KJH- Gym 1 arrive by 11am- Camp times 12pm- 6pm
20 Tuesday UCA Cheer Camp- KJH- Gym 1 arrive by 8am- Camp times 9am- 4pm
21 Wednesday UCA Cheer Camp- KJH- Gym 1 arrive by 8am- Camp times 9am- 4pm
August 2021 August
Su M Tu W Th F Sa 2-6 AUGUST Athletic Dead Week (Will not Practice July 30- Aug 8)
9-13 AUGUST Mandatory 14 Practices begin on August 9
1 2 3 4 5 6 7 for our first Football game- KJH- 8 to 10 am (Gym 2)
8 9 10 11 12 13 14 16-26 AUGUST Mandatory 14 Practices- KJH- 3pm to 5pm (Gym 2)
15 16 17 18 19 20 21 21 Saturday Bulldog Night Fundraiser/Performance- Time TBD
22 23 24 25 26 27 28 27 Friday First Football Game- Location and time- TBD
17 Tuesday ***Deposit #4 Due for all cheerleaders with a remaining balance***
For the 2021-2022 season- an athlete must pay their account
before ithey are allowed to perform (Season items will not be released
29 30 31 to cheerleader until items have been paid for in full)
*Remaining Fall Schedule TBD
00-049Calendar Template by Vertex42.com 00-049https://www.vertex42.com/calendars/school-calendar.htmlYou can also read
