UNCG Spartan G s 2015 SPRING TRYOUTS INFORMATION PACKET



Similar documents
PHYSICAL EXAMINATION FORM (ATHLETE) To be filled out by Health Care Provider

NORTH CAROLINA STATE UNIVERSITY DANCE TEAM

CHECKLISTS OF ATHLETIC TRAINING INFORMATION

The University of Louisiana at Monroe Cheerleading Tryout Packet

All forms are to be completed and returned to: The University of Denver Attn: Sports Medicine, Room E. Asbury Ave. Denver, CO

Student-Athlete Insurance Information Form PLEASE INCLUDE A COPY OF YOUR INSURANCE CARD (BOTH SIDES)

Dear Potomac State College Student Athletes and Parents:

NEW STUDENT-ATHLETE MEDICAL HISTORY FORM

Point Park University Medical Packet CONTENTS

KU Summer Camp Registration Form 09 Please Print Clearly Due May 1, 2009 * REQUIRED INFORMATION

TARLETON SPORTS MEDICINE. Student-Athlete Medical Information

NEVADA SPIRIT TEAM TRYOUTS Cheer/ Pom/Stunt/Mascot

San Diego State University CHEER TRYOUT INFORMATION PACKET

ECKERD COLLEGE RELEASE AND WAIVER: CAMP PROGRAMS PARTICIPANTS

FURMAN UNIVERSITY SPORTSMEDICINE CENTER

WICOMICO COUNTY ATHLETIC PACKET

UNIVERSITY OF MISSOURI GOLDEN GIRLS TRYOUT INFORMATION PACKET

Thank you for your interest in Western Carolina University Cheerleading!

Gavilan College Sports Medicine Emergency Contact / Insurance Information

Missouri Valley College Sports Medicine Staff

Truett-McConnell Athletic Training Forms

Midwest Cheer Elite All-star Hip Hop Information

Dear Alderson Broaddus Student-Athlete:

Athletic Training Department * 320 S. Main St. * Olivet, Michigan * Fax (269)

THE CENTER FOR GLOBAL EDUCATION & CITIZENSHIP

ELMIRA COLLEGE SPORTS MEDICINE INFORMATION, POLICY AND PROCEDURE MANUAL FOR ATHLETES

LEES-MCRAE COLLEGE HISTORY FOR ANNUAL CHECK-UP. TODAYS DATE:, 20 Sport:

NORTH CAROLINA HIGH SCHOOL ATHLETIC ASSOCIATION SPORT PREPARTICIPATION EXAMINATION FORM

CHILDREN ON CAMPUS PARTICIPATION AGREEMENT AND WAIVER FORM

Arcadia University Medical Clearance Packet

Portland State University Sports Medicine Returning Student Athlete Health Report Form

UNIVERSITY OF TOLEDO SPORTS MEDICINE POLICIES AND PROCEDURES

RARITAN BAY AREA YMCA

Holy Family University, Student Health Services, Directions for Completion of Health Packet

Olathe North High School Cheerleader

Ohio State Cheerleading Team Tryout/ Team Selection Information

PARTICIPANT AGREEMENT RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

The following is a checklist, for your personal use, of all the forms that must be returned to Manhattanville College Sports Medicine by August 1:

Workers Compensation Employee Personnel Forms

How To Participate In A Varsity Sport At A College Football Program

UNIVERSITY OF HOUSTON

INTERNATIONAL LEADERSHIP OF TEXAS

Alabama A&M University Sports Medicine. Athletic Injury and Medical Policy

THE UNIVERSITY OF TEXAS AT AUSTIN Texas Longhorn Boys Basketball Camp Fax: ATTN: Leslie Parks P.O. Box 7399 Austin, Texas

Davidson College Sports Medicine Football New Athlete Pre-Participation Letter

Northern Arizona University Athletic Training Insurance Requirements and Policies

TOWN OF POUGHKEEPSIE POLICE DEPARTMENT

FURMAN UNIVERSITY SPORTSMEDICINE CENTER

SPORTS INSURANCE PROPOSAL FORM (All questions must be answered in ink)

2016 Summer Camp Registration Form

CSUN Rebel Road Trip 2015 UNLV vs. SJSU

The New Mexico Activities Association physical form provides schools, parents and providers with a recommended form.

Amateur Sports Team & League Liability Insurance Application -No Participant Coverage-

Fran, Medical Assistant Kim, Office Manager, Referral Coordinator, Billing Specialist

All Students - Please complete items 1-5 All paperwork must have original signatures and be readable. No partial submissions will be accepted.

Sports Medicine Policies & Procedures

Single Married Divorced Widowed Student Minor African American Asian Caucasian Hispanic Other:

FOOTBALL CAMPS OF AMERICA, LLC CONSENT FORM

J UNE 15 - AUGUST 7 GRADES (going into) HEADSTART - 7th grade

Medical History Questionnaire

MILLENNIUM PHYSICAL THERAPY & SPORTS MEDICINE

San Diego State University Dance Team Auditions

This registration form is also accessible online at:

FIREFIGHTER I ACADEMY APPLICATION & CHECKLIST

2016 Bowdoin Summer Art Camp Registration

Bartow County C.E.R.T.

Sports Medicine Policy and Procedures

SPORTS MEDICINE POLICIES AND PROCEDURES

The University of Arizona Cheerleading Tryouts

Transcription:

UNCG Spartan G s 2015 SPRING TRYOUTS INFORMATION PACKET We discover and develop champions in life. - The Spartan Way

2015 UNCG Spartan G s Dance Team Spring Tryout Tryout Registration Fee: $20 Spring tryouts will be held Friday, April 10 and Saturday, April 11 Times and locations are as follows: Day 1: Friday, April 10, 2015 Time: 6:00pm-9:00pm Location: Men s Basketball Practice Facility, HHP Building 1st floor The Health & Human Performance Building is located at the corner of Walker Avenue & West Drive on the campus of UNCG. The Men s Basketball Practice Facility is located on the first floor of the HHP Building. Participants may park in the Walker Avenue Parking Deck at a rate of $1/hour. Day 2: Saturday, April 11, 2015 Time: 9:00am-3:00pm Location: Men s Basketball Practice Facility, HHP Building 1st floor The Health & Human Performance Building is located at the corner of Walker Avenue & West Drive on the campus of UNCG. The Men s Basketball Practice Facility is located on the first floor of the HHP Building. Participants may park in the Walker Avenue Parking Deck at a rate of $1/hour. All Tryout Sessions for the UNCG Dance Team are closed, without exception. Video Tryout Submission Submission of a tryout video will be accepted. However, situations will be handled on a case-by-case basis and the coaching staff reserves the right to deny the option of a video tryout at their discretion. All questions regarding UNCG Dance Team tryouts may be directed in writing to Marketing Director, Chandler Oliver, ncoliver@uncg.edu or Assistant Coach, Whitney Hickman wrhickma@uncg.edu. We discover and develop champions in life. - The Spartan Way

General Tryout Information All tryout participants must be: Current, full-time UNCG students (enrolled in a minimum of 12 credit hours) College transfers, or incoming freshman with an acceptance letter All tryout participants must have a minimum of a 2.3 semester GPA at the time of tryouts. Tryout Attire You must present a clean cut image to be selected as a Spartan G s dancer. Body piercings, tattoos, extreme hairstyles/color are not acceptable at tryouts or in uniform if selected as a team member. Remove all piercings and cover all tattoos prior to arrival at tryouts. Expected attire for tryouts is as follows: Friday: Colored bra top, form-fitting tank top or tee **Be creative. Rhinestones, costume accessories, etc. Stand out in the crowd!** Dark colored jazz pants or boy shorts Dance shoes Shoes must be worn at all times. ( Foot Undies or sandal soles may be worn) Saturday: Colored bra top, form-fitting tank top or tee **Be creative. Rhinestones, costume accessories, etc. Stand out in the crowd!** Dark colored jazz pants or boy shorts Dance shoes Game Day makeup Hair down and out of face Shoes must be worn at all times. ( Foot Undies or sandal soles may be worn) We discover and develop champions in life. - The Spartan Way

General Tryout Information continued Tryout Paperwork Requirements All tryout participants must submit the following paperwork and tryout registration fee, $20 checks made payable to UNCG Athletics, no later than Friday, April 3rd. NO EXCEPTIONS! The Tryout Application and the paperwork included in the UNCG Dance Team Tryout Packet must be submitted directly to the UNCG Dance Team Staff Advisor using one of the methods listed below. All tryout participants are encouraged to submit all paperwork as soon as possible so any issues that may arise can be addressed prior to the final deadline. By Mail: UNCG Athletics c/o Chandler Oliver 1408 Walker Ave, 101B HHP Greensboro, NC 27402-6168 CHECKLIST: By Fax: To: Chandler Oliver Re: UNCG Dance Team Tryouts Fax Number: 336.334.4063 By Drop-off: Room 101 B, HHP Building Attn: Chandler Oliver Tryout Registration Fee: $20, check made payable to UNCG Athletics UNCG Dance Team Tryout Application (Appendix A) All questions on the application must be completed before the application will be processed. Headshot (both listed below) Please submit a photo headshot of yourself and submit along with the other required paperwork. AND Photo copy of UNCG Student ID, if you are a current student Proof of full-time enrollment at UNCG Documentation must be provided via a print-out from UNCGenie that must contain participant s name and current GPA (Appendix B) Copy of 2015 Fall Class Schedule (Appendix C) Students are considered full-time only if they are enrolled in a minimum of 12 credit hours Acceptance letter to UNCG, if an incoming freshman or transfer student Copy of current physical (conducted within the past 6 months) (Appendix D) **(Must be signed by physician) Health Insurance Information Form (Appendix E) A copy of the front and back of the participants insurance card must accompany this form Consent to Disclose Protected Health Information Form (Appendix F) This form will only be kept on file should the participant be selected as a member of the squad This form requires the signature of a parent or legal guardian, regardless of participant s age ICA Agreement & Release Form (Indemnity Form) (Appendix G) Participants must have a parent or legal guardian s signature This form requires the signature of a parent or legal guardian, regardless of participant s age Insurance Information Form (Appendix H) This form requires the signature of a parent or legal guardian, regardless of participant s age Sickle Cell Screening Results (Appendix I) **Returning members DO NOT have to complete this requirement. Prospective new members only! Lab Results and Appendix I must be submitted before tryouts. No exceptions. Please give 24 to 48 hours to receive your lab results. Appendix I requires the signature of a parent or legal guardian, regardless of participant s age. We discover and develop champions in life. - The Spartan Way

General Tryout Information continued It is mandatory that you attend the tryout process. Candidates will be judged on, but are not limited to: Double Pirouette Triple Pirouette 4 or more Fouette turns Leaps (Jacquie, jete, second) Tryout dance (taught at tryouts) Freestyle Special Trick Cadences (taught at tryouts) Across the floor combo (taught at tryouts) Do not assume that a weakness or lack of skill in any one area will automatically disqualify you as a team member. Display an eager and positive attitude at all times. Candidates will tryout in groups of three and will be assigned by the coaching staff on Friday. The coaching staff along with the Staff Advisor will make all final decisions on team member selection. Any candidate that has questions after the team selections are announced may e-mail the UNCG Dance Team Staff Advisor any time AFTER the weekend. Outbursts or questions from parents will not be accepted. If you have ANY questions regarding paperwork or the general audition process, please contact the staff advisor in advance! Being proactive will insure you are prepared and cleared to participate in auditions. We are looking well-rounded dancers with outstanding skills, technique and SCHOOL SPIRIT! Keep working on your skills! We look forward to meeting and working with you! GO SPARTANS! We discover and develop champions in life. - The Spartan Way

UNCG Dance Team Q&A Q: Do you offer any partial or full scholarships for dancers? A: No scholarships are currently provided to UNCG Dance Team members. Q: What is the UNCG Dance Team squad size? A: Our maximum squad size is 20 dancers. Q: When are tryouts? A: The UNCG Dance Team holds tryouts in mid April. If needed, a Fall tryout will take place but will not always occur. Q: What are the additional benefits of being a UNCG Dance team member? A: The UNCG Dance Team is sponsored by the UNCG Athletic Department. Team members are able to pre-register for classes, have access to the Athletic Training room and staff, study hall room, strength and conditioning coaches, uniforms, shoes, travel accommodations and meal stipend when traveling and tickets to UNCG s home athletic events. Q: Does your team compete? A: Currently, the UNCG Dance Team does not compete. Q: Does your team attend summer camp? A: Yes, the UNCG Dance Team attends a summer camp. Q: Does UNCG have a cheerleading squad? A: Yes, the UNCG Cheerleading squad, is a part of the UNCG Spartan Spirit Program along with the UNCG Dance Team, UNCG Band of Sparta & UNCG Athletics Mascot, Spiro. We discover and develop champions in life. - The Spartan Way

UNCG SPARTAN G S DANCE TEAM AUDITION APPLICATION GENERAL INFORMATION NAME: (First, Middle, Last) UNCG STUDENT ID #: AGE: DATE OF BIRTH: (mm/dd/yy) CLASS RANK FOR THE 2015-16 ACADEMIC YEAR (circle one): FRESHMAN SOPHOMORE JUNIOR SENIOR OTHER UNCG E-MAIL ADDRESS: ALTERNATIVE E-MAIL ADDRESS: PERMANENT ADDRESS (PARENT S ADDRESS): (Street Address) (City) (State) (Zip Code) CELL PHONE #: HOME PHONE #: MAJOR: EXPECTED DATE OF GRADUATION: MOTHER S NAME: CELL PHONE #: FATHER S NAME: CELL PHONE #: DANCE BACKGROUND INFORMATION HOW MANY YEARS HAVE YOU BEEN DANCING? PLEASE LIST THE NAMES OF TEAMS, STUDIOS, ETC. YOU HAVE DANCED WITH IN THE PAST AND HOW MANY YEARS YOU WERE WITH THAT ORGANIZATION: TEAM/STUDIO NAME YEARS WITH ORGANIZATION 1. 2. 3. 4. 5. PLEASE LIST ANY ACCOMPLISHMENTS YOU HAVE EARNED THAT YOU WOULD LIKE US TO BE AWARE OF: Page 1

UNCG SPARTAN G S DANCE TEAM AUDITION APPLICATION ADDITIONAL INFORMATION DO YOU HAVE ANY CONFLICTS WITH THE TIME COMMITMENT AND EXPECTATIONS DURING THE SUMMER OR UPCOMING SEASON? (I.E. WEDDINGS, TRAVEL, STUDYING ABROAD, WORK COMMITMENTS) IF YES, PLEASE EXPLAIN: DO YOU HAVE ANY SPECIFIC HEALTH CONDITIONS OR LIMITATIONS WE SHOULD BE AWARE OF? IF YES, PLEASE EXPLAIN: HAVE YOU BEEN UNDER THE CARE OF A PHYSICIAN WITHIN THE PAST YEAR? IF YES, PLEASE EXPLAIN: UNIFORM INFORMATION UNIFORM TOP SIZE: XS (30-32) S (32-34) M (34-36) L (36-38) UNIFORM PANT SIZE: SMALL MEDIUM MEDIUM LONG LARGE JAZZ SHOE SIZE: 5 7 9 5.5 7.5 9.5 6 8 10 6.5 8.5 TENNIS SHOE SIZE: 5 7 9 5.5 7.5 9.5 6 8 10 6.5 8.5 T-SHIRT SIZE: X-SMALL SMALL MEDIUM LARGE SWEATSHIRT SIZE: X-SMALL SMALL MEDIUM LARGE SWEAT PANT SIZE: X-SMALL SMALL MEDIUM LARGE WARM-UP JACKET SIZE: X-SMALL SMALL MEDIUM LARGE WARM-UP PANT SIZE: X-SMALL SMALL MEDIUM LARGE SPORTS BRA SIZE: XS (30-32) S (32-34) M (34-36) L (36-38) Page 2

Appendix B Sample print-out from UNCGenie: Your Name Here

Sample print-out from UNCGenie: Appendix B

UNCG CHEER AND DANCE PHYSICAL Name: Date: Sport: CHEER / DANCE School Address: University ID: DOB: Telephone Number: Parents Name: Parents Address: List any allergies (including latex): Last Tetanus: Medications currently taking (including birth control): *Please answer the questions below. Fill in details of yes answers in space provided.* 1. Have you ever been hospitalized? Yes No 2. Have you ever had surgery? Yes No 3. Have you ever passed out during exercise? Yes No 4. Have you ever been dizzy during exercise? Yes No 5. Have you ever had chest pain during exercise? Yes No 6. Have you ever had a head injury, seizure or unconscious? Yes No 7. Have you ever had heart trouble, or high blood pressure? Yes No 8. Has anyone in your family died suddenly before the age of 50 of heart problems? Yes No 9. Have you ever had a heat related illness?(cramps, dizzy or passed out) Yes No 10. Do you have any other medical problems?(ie asthma, diabetes, hepatitis, Impaired function of any organ) Yes No 11. Do you have any menstrual irregularities or problems? Yes No 12. Do you wear glasses, contacts, braces of any kind, orthotics, hearing aid? Yes No 13. Have you ever injured (sprained, dislocated, fractured etc)? Circle all that apply. Neck Chest Hip Thigh Knee Ankle Foot Toes Lower Leg Elbow Arm Wrist Back Head Fingers Shoulder

Page 2 EXAMINATION Height Weight RHR BP Heart Lungs Abdomen General Other MUSCULOSKELETAL Neck Back Shoulder Knee Elbow Ankle Wrist Foot Hip Hand ASSESMENT RECOMMENDATION CLEARANCE No Restrictions Deferred Until Name of Provider Signature of Provider Date

Appendix E Health Insurance Information for 2015-16 Academic Year Athlete s Name Date of Birth / / Last First MI Athlete s Home Address City State Zip Code Athlete s University ID # Athlete s SS# Sport Complete Name of Insurance Company Address to Mail Claim Policy Holder s Name Last First MI Policy Holder s Address Number Street City State Zip Code Policy Holder s SS# - - Policy Holder s DOB / / Please copy the front and back of your insurance card and affix it below. (Front) (Back)

Appendix F Consent to Disclose Protected Health Information I hereby consent to allow the UNCG Athletic Training Staff to disclose Protected Health Information concerning any injury or athletically related illness to my coaching staff and the UNCG Athletics Administration. I hereby consent to allow UNCG Athletic Department Personnel to disclose Protected Health Information concerning any injury or athletically related illness to my parents, legal guardians, or wards. I authorize payment of medical benefits to all providers of services for all services and materials they provide during the care of any injury/illness. I agree to supply any and all information requested by my primary insurance, UNCG and the excess insurance company, and the NCAA and their excess insurance company in a timely manner in order to expedite the claim process. I hereby authorize UNCG and their excess insurance company to secure and inspect copies of case history records, lab reports, diagnoses, x-rays, and other data pertaining to the injury/illness I am receiving care for or previous confinements, if disabilities relevant, to the care of the injury/illness. I authorize the UNCG Athletic Training staff and/or my coach to hospitalize and secure treatment for me for any athletic injury/illness. If the athlete is under 18 years of age, the undersigned parent/guardian grants permission the UNCG Athletic Training staff and/or the coach to hospitalize and secure treatment for their son/daughter/ward for any athletic injury/illness. This consent is irrevocable for the duration of any executed disclosure due to an athletically related illness or injury. A photo static copy of this consent shall be deemed as effective and valid as the original. I will notify the UNCG Athletic Training staff immediately upon any change in the above health insurance information. Athlete s Signature Parent/Guardian Signature Date Date Parent/Guardian s Name Relationship Home Phone Work Phone Parent/Guardian s Name Relationship Home Phone Work Phone Alternate Person to Contact in Case of Emergency Relationship Home Phone Work Phone

Appendix G UNCG Athletics Waiver, Release of Liability, & Indemnity Agreement I am aware and understand that any physical activity, including (but not limited to) soccer, basketball, volleyball, tennis, baseball, softball, cheerleading, weight lifting and conditioning, can be a dangerous activity, which may result in serious personal injury. These injuries include, but are not limited to, serious neck and spinal injuries, complete or partial paralysis, brain damage, serious injuries to bones, joints, ligaments, and tendons; serious injury to other areas of the body, general health and well-being, and even DEATH. In consideration of the University of North Carolina Greensboro (UNCG) permitting me to use its Athletic Facilities, I agree to the following: I will obey all rules established by UNCG Athletics for the use of its facilities. I will obey any and all instructions or directions given to me by UNCG Athletic personnel concerning the use of its facilities. I assume all financial responsibility for any injury or damage as a result of my use of UNCG Athletic Facilities. To the fullest extent allowed by law, I hereby release and agree to hold harmless UNCG, its trustees, officers, agents, employees, coaches, professors, students, athletic trainers and other medical personnel from any and all liability arising out of any injuries to my person or property, or losses of any kind or nature whatsoever, which may result from, or which arise in connection with, my use of the UNCG Athletic Facilities, even to the extent that such injuries may arise from the negligence of those listed above. To the fullest extent allowed by law, I will indemnify and hold harmless, including attorney s fees and court costs, those listed above for any injury to person or property that I may cause others in the course of my use of the UNCG Athletics Facilities or due to my failure to obey any rules, directions, or instructions. I acknowledge that I have read this agreement fully and that I understand the legal rights I waive by signing this agreement. I further acknowledge that I am aware of the potential hazards incident to engaging in physical activity. Signature of Participant Date Signature of UNCG Representative Date Printed Name of Participant Printed Name of UNCG Representative Printed Name of Parent/Guardian Date Signature of Parent/Guardian

Appendix H Insurance Information 2015-16 The UNCG Department of Intercollegiate Athletics carries an excess accident insurance policy for each student-athlete. This policy carries a $3,000 per injury deductible. In other words, you and/or your primary medical insurance company must make $3,000 in actual payments before this insurance policy is activated. Beginning in the fall of 2007, UNCG will require all students to have primary medical insurance. This change is university wide, and not a policy of the Department of Intercollegiate Athletics. It will be the responsibility of each student to prove that he/she has medical insurance and if not, the student account will be billed automatically, $365.00 per semester. Please see the attached document for step by step directions as to how to show proof of insurance. We strongly recommend that you research and understand your insurance benefits prior to your arrival on campus. If the benefits are insufficient or non-existent (HMO) in NC, you may wish to call your carrier to inquire about alternatives. Another option would be to default to the school policy. When a student-athlete is injured, all medical insurance claims will be filed with your personal insurance company. Once proof of $3,000 in payments is available, the following information is required from the student-athlete in order to process a claim with the excess accident insurance company: 1) Itemized bills from all medical providers 2) Explanations of Benefits (EOB s) from your medical insurance company The UNCG Athletic Training staff will assist in expediting the dissemination of this information to the excess accident insurance company and process the remaining portion of the claim for you. Please be advised that should a balance still exist after both primary and excess accident insurance have paid, this will be the responsibility of the athlete. All injuries must be reported to a staff athletic trainer. We will advise the student-athlete of the proper protocol that must be taken to insure proper payment by all insurance companies involved. At no time should the student-athlete seek medical treatment without the prior approval of the Athletic Trainer. This action will jeopardize and/or remove responsibility from UNCG and its excess accident insurance company for payment of medical bills. Your signature on this letter indicates that you have read, understand and will comply with all that is stated above. Any false information will nullify UNCG from responsibility regarding any medical bills. I, have read the above letter and understand that UNCG is responsible on a secondary basis only for injuries which occur in an official UNCG athletic practice or competition. I also verify that all the insurance information that I have provided is correct and complete. Student-Athlete Signature Parent Signature Date Date

Appendix I UNIVERSITY OF NORTH CAROLINA at GREENSBORO SPORTS MEDICINE Sickle Cell Trait Screening Declination and Release of Claims **Must submit this form along with Sickle Cell Results (signing this form is NOT a replacement for testing, still must have Sickle Cell trait screening) About Sickle Cell Trait: Sickle cell trait is an inherited condition of the oxygen-carrying protein, hemoglobin, in the red blood cells. Sickle cell trait is a common condition (> three million Americans). Although Sickle cell trait is most predominant in African-Americans and those of Mediterranean, Middle Eastern, India, Caribbean, and South and Central American ancestry, persons of all races and ancestry may test positive for sickle cell trait. Sickle cell trait is usually benign, but during or after exercise, hypoxia(lack of oxygen) in the muscles may cause sickling of red blood cells(red blood cells changing from a normal disc shape to a crescent or sickle shape), which can accumulate in the bloodstream and logjam blood vessels, leading to collapse, personal injury and/or DEATH from the rapid breakdown of muscles starved of blood. If the UNCG Sports Medicine Staff and the student-athlete s coaches are made aware that a student-athlete has sickle cell trait, then collapse, personal injury and/or DEATH from exercise may be avoided or decreased if the student-athlete follows the directives of the Staff and his/her medical professionals. Such directives may include, but not be limited to, reduced or modified activity during practice and/or games. Sickle Cell Screening: If the student-athlete does not have knowledge of their sickle cell trait status, the NCAA recommends that screening is performed. In order to decrease the risk of collapse, personal injury and/or DEATH to its student-athletes, the University of North Carolina Greensboro requires that all student-athletes who do not know their sickle cell status undergo the screening. I,, (parent or guardian name here if student-athlete is under 18)understand and acknowledge that, in order to decrease the risk of collapse, personal injury and/or DEATH to its student-athletes the University of North Carolina at Greensboro recommends that all student-athletes have knowledge of their sickle cell trait status. Additionally, I have read and fully understand the aforementioned facts about sickle cell trait and sickle cell trait testing. I understand that exercising without knowledge of sickle cell trait status can increase the risk of collapse, personal injury and/or DEATH during or after exercise. I hereby affirm that I have fully and accurately disclosed in writing any prior medical history and/or knowledge of sickle cell trait status to UNCG Athletic Training staff. I do not wish to undergo sickle cell trait testing (in the case of a minor, the parent or guardian does not wish the minor to undergo sickle cell trait testing) through UNCG, as I (or my dependent) has been screened previously and I am able to provide these results. I (or in the case of a minor the parent or guardian) voluntarily agree to release, indemnify and hold harmless, regardless of their negligence, the State of North Carolina, the University of North Carolina at Greensboro, its officers, employees, agents and volunteers from any and all costs, liabilities, expenses, claims, demands, or causes of action on account of any loss, personal injury or DEATH that might result from this decision to not be screened for sickle cell trait and/ or from any incorrect information that I or any person on my behalf provided to UNCG Athletic Training staff about sickle cell trait status. I have read and signed this document with full knowledge that I may be giving up rights that I may otherwise be entitled to if I had not signed it. I am at least 18 years of age and competent to sign this waiver. Student-Athlete Signature Sport Parent/Guardian Signature Date Date University ID#