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Grand Canyon University

2016-2017 Dance Team Tryouts

Please read this packet thoroughly. If you have any questions about the GCU Dance Team or tryouts requirements not answered in this packet,

please contact Head Coach Jacque Genung-Koch jacque.genung-koch@gcu.edu

Program Overview � Mission � Objectives � Description of Team � Requirements � Time Commitment & Expectations � Benefits

GCU Dancers Tryouts

� Check-List & Packet Submission information � Description of Required Materials � Tryout Dance & Skills Requirements � Anticipated Tryout Schedule � Required Tryout Attire � GCU Campus Map � Sample Interview Questions � General Tryout Information & FAQ � Athletic Training Forms � Waiver and Release from Liability � Tryout Acknowledgement & Acceptance

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PROGRAM OVERVIEW

Mission

The mission of the Grand Canyon University Dance Team is to support, promote, and represent Grand Canyon University through proper promotion of school spirit, pride, tradition, and student involvement.

Objectives

• Support and perform at multiple GCU Athletics teams’ games and matches.

• Support University Relations by attending and promoting various events on campus and within the community.

• Display appropriate collegiate level of dance skills, technique, and rallying, and reinforce those concepts during games and performances.

• Demonstrate qualities of commitment, discipline and responsibility, as well as serve as exceptional representatives and ambassadors of Grand Canyon University, the GCU Spirit Program and the GCU Dance Team.

Description of Team

• Dance performance team that incorporates a variety of Jazz, Hip Hop, and Pom movement styles

• GCU Athletic team under the supervision of GCU University Relations & Campus Events

• ONE dance team consisting of two squads; performing together and/or separately contingent on situation.

• New this Season! As our men’s basketball is our highest profile and televised sport; there is a demand for our most entertaining and engaging dancers to perform at these events. Purple and White squad selection will be determined by experience, spirited rallying skills, dance performance ability, as well as attitude, grades and overall performance in all team aspects. Both squads are held to the same high level of technical ability, and will participate equally in appearances, promotions, clinics, community outreach, and other sporting events. Members from either squad may audition for participation in Nationals if applicable. Squad selection will happen in late August, and is subject to adjustment all season as the coach sees fit.

Requirements – All Mandatory

• Must be accepted and enrolled as a fulltime, traditional ground-based program student at GCU prior to tryouts.

• Must have a current physical (within past 6 months) and carry medical insurance in order to tryout.

• Each semester, must be enrolled as a full-time student at Grand Canyon University (12 credits per semester). Must have and maintain a 2.0 GPA to be eligible for scholarship, maintain a C (75%) or above grades in all classes order to participate, and provide bi-weekly grade checks.

• Must be available to attend listed summer practices, work-outs, and dance camps.

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• Must be able to commit to an average of 20+ hours per week during the season for practice, work-outs, games, events and various functions.

• Must show an understanding of responsibility regarding maintaining health and wellness, nutrition, safety, and injury prevention.

• Must abide by all rules and regulations set by NCAA Division I (National Collegiate Athletic Association) and the Western Athletic Conference which GCU athletics falls under as they pertain to collegiate dance teams.

• Must abide by all athletic policies & guidelines, including drug & tobacco policies, random drug testing, required GPA of 2.0 for eligibility, medical insurance coverage and behavioral conduct standards as they pertain to the cheerleading/dance team program.

• Must be a mature adult, with a positive attitude where you are willing to learn, accept constructive criticism and be a team player.

• Must possess a strong dedication to academic excellence and show commitment to being a servant leader.

• Must show ultimate acceptance of the above dance team mission statement.

• Financial Obligations:

� A $150 non-refundable Camp Fee will be due upon making the team on April 10th.

� An additional $150 Team Fee will be due August 1, 2016.

� Dance team members are required to purchase certain personal items including dance shoes and undergarments.

� Our Eastbay Online Shop will go live the week after tryouts. The Shop is where you will purchase Nike items to use throughout the year at discounted prices. Some items will be mandatory for you to purchase for team use, but several items will be available to purchase at your discretion. The Dance Team Eastbay Online Shop URL will be provided at tryouts.

Time Commitments & Expectations – All Mandatory

• Attend summer work-outs/dance classes OR follow set home work-out/dance technique regime if you live outside the Phoenix area or when you travel outside the Phoenix area.

• Attend New Student Orientations if in Phoenix area during given dates.

• Attend Summer Practice June 22-24.

• Attend USA College Dance Camp in Nevada - July 20-July 22. (Small group attending)

• Move in to GCU Student Housing – July 29.

• Attend GCU Dance Team Pre-camp – August 1-9.

• Attend UDA Collegiate Dance Camp in California OR Attend GCU Dance Team Home Camp – August 9-13. (Dancers attending UDA camp may be announced as late as pre-camp. Dancers not attending UDA camp will attend GCU Dance Team Home Camp rehearsal at GCU during this time.)

• Attend GCU Team Week – August 14-21

• GCU Welcome Week activities - August 22-28; school & regular practice schedule starts August 29.

• Attend all season practices and strength/cardiovascular training starting at the beginning of fall semester & continuing through mid-April 2017. In general, a commitment of 20+ hours per week can be expected with practices, training, and performances. Anticipated practice

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schedule includes strength/cardio training 3 times per week, dance rehearsal 3 times per week, and required study hall hours. Exact dates & time will be announced at tryouts.

• Missed practices, games or events are NOT permitted, unless there is an emergency situation. Family vacation, work conflicts, etc. are not reasons for missing practice, games or events.

• Perform at home men’s and women’s basketball games, other GCU athletic events, and select university & community events. Be available for all games that might be scheduled over Thanksgiving, Christmas & Spring Break. NOTE: GCU traditionally has games the day before or after Thanksgiving, as well as during Christmas & Spring Break. YOU WILL BE REQUIRED TO BE IN ATTENDANCE AT THESE GAMES. It’s a great time for team members’ families who live outside of Phoenix to come enjoy the holidays in the sun!

• Must be a responsible adult and treat dance team commitments like a job where you are accountable, timely and disciplined. Must possess excellent time management skills.

• Able to schedule priorities with academics first, then dance team…nothing in between.

• Have a mature & positive attitude. Be honest, respectful & dependable.

• Must exhibit appropriate personal conduct, on and off the performance floor. It is critical that the GCU Dancers are a positive reflection of GCU and align with the 4 pillars upon which GCU was founded: Academic Advancement, Christian Camaraderie, Extra Curricular Excellence and Wellness & Well-Being.

• Must be willing to learn, accept instruction from coaches & captains, respect all decisions of coaches & captains and respect the integrity of the program.

Benefits

• Scholarships available to all team members.

• Nike gear and custom designed uniforms and practice attire provided by GCU.

• Opportunity to perform at GCU Athletics including men’s and women’s basketball games in GCU arena & affiliation with an NCAA Division I athletic program.

• Use of GCU’s athletic weight room, athletic training facilities and staff, and nutrition support.

• Possible attendance at UDA & USA College dance camps.

• Possible travel for NCAA athletic tournaments and championship games.

• Possible opportunity to compete in UDA or USA national collegiate dance competitions.

• Opportunities for professional development and networking within University partnerships.

• A solid network that fosters personal purpose and growth from the challenge of a dynamic Christian dedicated team.

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DANCE TEAM TRYOUTS CHECKLIST _____Complete the online GCU Dancers Application by March 26th found at www.gcudancecamps.com

_____$25 NON-REFUNDABLE tryout fee at www.gcudancecamps.com; $3.00 service fees may apply

_____Mail the Tryout Packet: • Printed on regular, WHITE printer paper • Postmarked NO LATER THAN Saturday, March 26th

In the following order:

_____Tryout Acknowledgement & Acceptance – Page 24

_____Waiver and Release from Liability – Page 23

_____8x10 Headshot photo – requirements on Page 6

_____Dance Action photo – requirements on Page 6

_____Dance Résumé – requirements on Page 6

_____2 Letters of Recommendation by coaches/dance instructors – requirements on Page 6

_____Copy of GCU Acceptance Letter

_____Athletic Training Forms:

_____Student Athlete Heath Report – Page 13

_____Physical Examination Form – Page 14

_____Health History Questionnaire – Pages 15-18

_____Heat Acclimation Questionnaire – Page 19

_____Copy of front & back of Primary Insurance Card – requirements on Page 7

_____Student-Athlete Acknowledgement and Consent Signature Page – Page 22

ALL PAPERWORK & FEES LISTED ABOVE MUST BE PPOOSSTTMMAARRKKEEDD NO LATER THAN SATURDAY, MARCH 26 OR HHAANNDD DDEELLIIVVEERREEDD AT THE DANCE TEAM PREP CLINICS ON SATURDAY,

MARCH 19th or MARCH 26th. Mail to: Grand Canyon University ATTN: Jacque Genung-Koch, Head Dance Team Coach Cypress Hall 108 3300 W. Camelback Rd., Phoenix, AZ 85017

LATE SUBMISSIONS WILL NOT BE ACCEPTED!

Prepare for the Dance Tryouts on April 8th-10th:

_____Learn Audition Material - a link with video of choreography will be emailed to you by April 2nd _____Choreograph Solo - requirements on Page 7 _____Work on dance technique skills & Prepare for Interview questions – see lists on Page 7 & Page 11 _____Prepare for Strength & Conditioning evaluations – see list on Page 7 _____Optional: Attend GCU Prep Clinics – see details on Page 12

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DESCRIPTION OF REQUIRED TRYOUT MATERIALS

Online Application Please complete the online GCU Dancers tryout application found at http://www.gcudancecamps.com NO LATER THAN March 26th – includes a $25.00 NON-REFUNDABLE tryout fee (plus service fee).

Headshot Photo Please submit a COLOR 8x10 standard headshot photo. Please reference our team roster bio headshots as an example. Photos should be recent, and display your current hair color/length/style. Be sure you’re your headshot LOOKS LIKE YOU as you will look at the audition. Photos will not be returned.

Dance Action Photo Please submit a 4x6 or 5x7 dance action shot photo. Photos must be recent, and representative of your personal dance style. Be sure you’re your action shot LOOKS LIKE YOU as you will look at the audition; you must be recognizable to the judging panel in the photo. Photos will not be returned.

Dance Résumé Please submit a one-page, current dance resume highlighting your dance performance experience and dance training. Résumé should be organized, professional, and clean.

Two Letters of Recommendation Recommendations should be from current coach or dance instructor. If this is not possible, a

previous coach or instructor will be accepted. We will not accept letters from friends or family. Letters of recommendation must be SIGNED and SEALED, and should include ALL of the following: • Role they had in your life and duration of your relationship with them • Evaluation of your abilities, character, and contributions; specific examples of strengths • Summary that explains why they would recommend you for the GCU Dance Team • Contact information for further reference

GCU Acceptance Letter Please submit a copy of your GCU Acceptance Letter. If you have not received your acceptance letter, your enrollment counselor may email your status, and you may include this email with your tryout packet. If you are a current GCU student, please submit documentation of your present status.

Athletic Training Forms All candidates are required to have a current physical (completed within the past 6 months) in order to tryout. If you have a current physical, provide a copy of the physical. You will still need to complete the other forms. If you do not have a current physical, please use our form. Athletic Training Forms include:

• Student-Athlete Physical Examination - This must be completed and signed by a physician. You must also sign the bottom of this form. If you are providing a copy of your current physical (completed within the past 6 months), this is the form you are replacing with your current physical.

• Health History Questionnaire - Complete all four pages of the form entirely. For every box you have marked with a “YES” answer, please include an explanation in the space provided, and list year of injury or illness. Remember to sign your name at the bottom. Please have the physician look over this form before your physical. The ATC at GCU will screen the form and sign it in the provided spaces.

• Heat Acclimation Questionnaire - The purpose of this form is to help the athletic training staff determine if you are at risk for heat illnesses. Please read and answer all questions.

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• Medical Insurance Card - All candidates are required to carry current medical insurance coverage. Please submit a legible copy of both the front and back of the card. The card is needed in case of an emergency situation or to set up appointments with the team physicians.

• Athletic Training Forms Signature Page - Please read the information for each of these specific areas: ACKNOWLEDGEMENT OF RISK, CONSENT TO TREAT AND TRANSPORT, CONSENT TO RELEASE MEDICAL INFORMATION, AUTHORIZATION FOR DISCLOSURE OF PROTECTED HEALTH INFORMATION, and ACKNOWLEDMENT RECARDING SECONDARY INSURANCE INFORMATION, then sign and submit the last page. MINORS: If you are not yet 18 years of age, please be sure that your parent/guardian also reads all Athletic Training information and includes their signature on the signature page.

DANCE & SKILLS REQUIREMENTS FOR TRYOUTS

• Pom Routine, Jazz Routine, & Hip Hop Routine – a link with video of choreography will be emailed to applicants who have submitted all required materials. This link will be sent by April 2nd. Please have routines ready for performance at the tryout.

• Technical skills required for demonstration at the tryout will include*: o Turns:

� Triple/Quadruple parallel pirouettes � À la seconde turns; including quarter turns & switching/changing spots � Right leg-hold turns (single and/or multiple)

o Leaps: � Turning disc � Side, center and switch leaps

o Inversions: � Aerial � Front Walkover � Headspring

� Headstand � Kip Up

o Extensions: � Penchée arabesque � Pitch extension � Grand Battements/high kicks

*Skills may be incorporated into choreography, or may be asked to perform separately.

• Applicant Prepared Solo Choreography – Requirements for solo: o Must be of Jazz, Contemporary Jazz, Hip Hop, or Pom style o Must be 1 minute in length o Must be your own choreography o Accompaniment must be on mp3 player to plug into sound system o You may be asked to perform this choreography multiple times

• Outstanding performance, rallying, and freestyle ability

• Strength & Conditioning: o Timed Plank o One Minute Squats

o One Minute Push-ups o Beep Test

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ANTICIPATED TRYOUT SCHEDULE

Friday, April 8 @ 3:30 -10:00 PM, Lopes Performance Center Studio (see map on page 9)

• 3:30-4:00pm Check-In & warm-up/stretch on own

• Across floor

• FIRST CUT – announced live

• Strength & conditioning evaluations

• Dance routine audition

• SECOND CUT – announced Live

• Review dance team policy & procedures

• Review dance & skills material for Day 2

Saturday, April 9 @ 8:30AM – 10:00 PM, Lopes Performance Center Studio (see map on page 9) • 8:30-9:00am Check-In

• Interview panel – Please dress in professional attire; see page 10 for sample questions

• Change into dance attire & warm-up/stretch on own

• Rallying and crowd appeal

• THIRD CUT – announced live

• Dance routine audition

• FOURTH CUT – announced Live

• Solo audition

• FINAL CUT – YOU WILL RECEIVE AN EMAIL BY MIDNIGHT WITH YOUR RESULTS

Sunday, April 10 @ 9:00AM – 4:00 PM, Lopes Performance Center Studio (see map on page 9)

• First team dance practice

• Team building activities

• Uniform and practice/camp attire fitting

• $150.00 camp fee due

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REQUIRED TRYOUT ATTIRE Friday, April 8th

• Black spandex shorts

• Solid color, fitted tank top

• Athletic shoes for strength & conditioning evaluations

• Jazz shoes, hip hop shoes, and/or turners for dance audition

• Hair MUST be half up/half down (or similar for shorter hairstyles) for dance audition

• Make-up should be performance/collegiate game day ready

• Bottom-hole stud earrings only

• All visible tattoos covered Saturday, April 9th

Interviews

• Professional/business attire – modest dress or blouse and dress pants, professional footwear

Dance audition

• Black ankle length leggings

• Solid color, fitted tank top

• Jazz shoes, hip hop shoes, and/or turners for dance audition

• Hair MUST be worn DOWN, styled for performance and out of your face for dance audition

• Make-up should be performance/collegiate game day ready

• Bottom-hole stud earrings only

• All visible tattoos covered Solo audition

• You may wear attire appropriate for the style of your solo audition, or may remain in your audition attire from the first portion of the day. Please remember to maintain a collegiate look representative of a GCU Dancer.

Sunday, April 10th

• Solid black fitted top – no visible logos

• Solid black spandex shorts or leggings – no visible logos

• Solid black sports bra

• Hair MUST be worn down, styled for performance and out of your face

• Make-up should be performance/collegiate game day ready

• Single stud earrings only

• All visible tattoos covered

• Jazz shoes, hip hop shoes, and/or turners

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Park

Here

Tryouts

Here

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SAMPLE INTERVIEW QUESTIONS

1. Our dancers must be a responsible adults. Tell us what qualities and actions you think define a responsible adult. Why do you feel this is important for our team?

2. How do you feel that the demands & expectations of dancers differ at the collegiate dance team level from that of the high school dance team/pom team or private studio level?

3. Tell us why you chose to attend GCU. How do you envision your college experience? How does dance team play a part in that?

4. You hear coaches and athletes talk about the importance of being a “team player.” What do you think it really means to be a team player? Why is this important for a college dance team?

5. Check your three strongest characteristics and/or the roles you assume in a team situation:

� Calm � Clarifier/Cleaner � Communicator � Competitive spirit � Conscientious � Creative � Decision-maker � Dedicated � Dependable � Disciplined

� Encourager � Flexible � Goal oriented � High energy � Humorous � Initiates activities � Initiates relationships � Kind � Leader � Listener

� Loyal � Motivator � Objective � Organized � Patient � Peacemaker � Self-motivated � Sincere � Task accomplisher

6. How do you plan to prioritize and manage your time as a full-time college student while keeping up with the commitments and demands of dance team?

7. Do you think that dancers are athletes? If so, what are specific ways you and our team can ensure all other athletic coaches, staff, fellow athletes and students see us that way?

8. Tell us how you think the dancer’s behavior can have a negative or positive impact on the program and/or the University. How do you feel your conduct & values will reflect upon this team?

9. Do you feel there is ever a time when you should question the direction of your coaches or captains? Please explain.

10. As a team, we highly value leadership abilities and qualities, and all members are expected to have vested leadership responsibilities within our team. What do you feel are your leadership strengths?

11. On our team, we also highly value the ability to go above and beyond, and to take initiation when others will not or cannot. Describe a time when you took initiation, or went above and beyond what was asked of you.

12. Besides dance, what are your other strengths, hobbies, skills, interests? What makes you a unique individual?

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GENERAL TRYOUT INFORMATION & FAQ What should I bring to tryouts? Please bring water, snacks, and dance shoes each day; bring a layer to wear during talking/presentation portions of the tryout to keep muscles from cooling down; bring a sack lunch/dinner for the longer days.

How can I prepare for tryouts? Attend the AUDITON PREP CLINICS, put on by the GCU coaching staff and veteran team members. Dates and times are:

Saturday, March 19 @ 12-2 pm Hip Hop & Pom (Lopes Performance Center) Saturday, March 26 @ 12-2 pm Jazz & Contemporary (Lopes Performance Center)

The prep clinics are not mandatory, but an opportunity to practice & receive help from the GCU coaches and veteran team members with dance technique, various skills and combinations. Please visit http://www.gcudancecamps.com to register. Clinic cost is $20/session, & each session provides new dance material and details about the dance audition.

How many members will make the team? This number is contingent upon how many candidates tryout, the talent level, and is up to the discretion of the director and coaches each season. We anticipate taking around 28 athletes this year.

Do veteran dance team members have to tryout? Yes. We believe it is very important for everyone to tryout each year to avoid complacency. All returning athletes are required to re-audition each year, though they are exempt from the first cut on the first day.

Do you have a separate tryout for incoming freshmen or out-of-state students? No. There is only one live tryout opportunity for prospective dancers to audition for the team.

I am traveling from out of town. Where can I stay? Grand Canyon University Hotel 5115 N. 27th Avenue, Phoenix, AZ 85017 Phone: 1-844-683-5428 Email: GCUHotel@gcu.edu Website: http://www.gcuhotel.com

Can I tryout by video? Video tryouts should only be requested by those who simply have no way to attend the live tryouts. Auditioning by video is not ideal – the judges cannot truly assess your abilities and performance in an adjudicated atmosphere, as compared to other candidates. If selected, video candidates will be placed on the team on a provisional basis and are required to attend the summer rehearsals for further consideration. If video audition is truly your only option for this year, please contact Coach Jacque Genung-Koch at jacque.genung-koch@gcu.edu to discuss the requirements and expectations.

What is the exact scholarship amount? All team members receive a scholarship upon making the team if all eligibility requirements are met. The exact amount varies each year and is based upon the program’s overall scholarship budget, the number of team members and the number of veterans/rookies – the longer you are on the team, the potentially higher scholarship you receive. In addition, the scholarship is combined with any other GCU scholarship(s) the member may have, and is restricted to the following combination limits:

• Presidents Scholars in campus housing may receive up to $16,500 • All other scholars in campus housing may receive up to $14,000 • All other scholars living off campus may receive up to $11,500

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2016 Grand Canyon University Student Athlete Health Report

Please Print

Name_____________________________________________________________________________Date________________________________ Last First Middle

Sport____________________________________________________________ �Male �Female Birthdate _____/_____/_____ Age_____ Social Security #_________________________________________ Marital Status �Married �Single Year in School___________________ Local Address (while attending GCU) _______________________________________________________________________________________ Local Phone #______________________________________________ Mobile Phone #______________________________________________ Pager #______________________Work Phone #________________________email _________________________________________________ Permanent (Home) Address_______________________________________________________________________________________________ Father’s Name _____________________________________________________Work Phone #_________________________________________ Address_____________________________________________________________________________ Home Phone #______________________ Mother’s Name ____________________________________________________Work Phone #_________________________________________ Address________________________________________________________________________Home Phone #___________________________

EMERGENCY INFORMATION Allergies: ______________________________________________________________________________________________________________ Medical Conditions: _____________________________________________________________________________________________________ Medication Currently Taking (including birth control pills): ______________________________________________________________________ In case of Emergency Notify: ______________________________________________________________________________________________ Relationship: ___________________________________________________________________________________________________________ Address______________________________________________________________City, State, Zip______________________________________ Home Phone #_____________________________Work phone #___________________________Mobile phone #_________________________

ATHLETIC INSURANCE PROFILE Personal Insurance Carrier________________________________________________________________________________________________ Insurance Carrier Address_________________________________________________________________________________________________ Insurance “Claims” Phone Number_________________________________________________________________________________________ Policy Number______________________________________________ Group number________________________________________________ Policy Owner’s Full Name_______________________________________ Employer__________________________________________________ Policy Owner’s Social Security #_________________________________Policy Owner’s DOB__________________________________________ Policy Owner’s Address___________________________________________________________________________________________________ Does your personal insurance carrier require you to go to certain doctors and/or hospitals? �Yes �No If yes, please specify_____________________________________________________________________________________________________

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2016 PHYSICAL EXAMINATION

TO BE COMPLETED BY PHYSICIAN

Name of Athlete Examined______________________________________________________________________________________________

Height_________ Weight_________ Pulse_________ Blood Pressure (1) _________ (2) _________ Visual Acuity (R) 20/______ (L) 20/_____

CLINICAL EXAM: Check each item in appropriate column. Elaborate as needed.

Nor Abn

_____________ H.E.E.N.T____________________________________________________________________________________________

_____________ Pupil Size___________________________________________________________________________________________

_____________ Skin________________________________________________________________________________________________

_____________ Heart________________________________________________________________________________________________

_____________ Lungs_______________________________________________________________________________________________

_____________ Abdomen____________________________________________________________________________________________

_____________ Hernia and Genitalia (males) _____________________________________________________________________________

_____________ Neurological__________________________________________________________________________________________

_____________ Spinal Column (scoliosis, etc.)____________________________________________________________________________

_____________ Upper Extremities_____________________________________________________________________________________

_____________ Lower Extremities_____________________________________________________________________________________

COMMENTS AND RECOMMENDATIONS:

_____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ RESTRICTIONS: _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________

Physician (PLEASE PRINT)

Physician’s Signature Date

Physician’s Address Phone Number

I agree that the information on this sheet is accurate to my knowledge and have asked questions regarding my health and understand and will

follow recommendations and restrictions as described above.

Student-Athlete Signature Date

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GRAND CANYON UNIVERSITY ATHLETIC TRAINING

2016 HEALTH HISTORY QUESTIONNAIRE

This information is confidential. Please answer all questions fully and explain all “Yes” answers in the space provided. This form must be completed and returned before the student-athlete will be permitted to practice or compete. Further medical evaluations may be required for specific problems.

Name __________________________________________________________ Date ___________________

Sport __________________________________ Social Security #_______________________________

GENERAL INFORMATION

1. Please list any prescription or non-prescription medications, supplements or vitamins you are taking on a regular basis (including birth control pills).

2. Please list ALL allergies to medications, environmental substances, adhesives, or any other allergies you may suffer from.

Yes No No Question: If yes, please explain: Have you ever fainted, felt like fainting or become dizzy either at rest, during, or after exercise?

Do you ever get short of breath with or after exercise?

Have you ever been told you had a heart murmur, high blood pressure or heart disease?

Have you ever had surgery or have been advised to have surgery at any time in your life?

Have you ever had chest pain or an irregular heart rhythm at rest or during exercise?

Have any blood relatives died before the age of 50 from natural causes (heart disease, cancer, etc.) or unexplained causes?

Have you ever had any illness that lasted longer than one week or caused you to miss a practice or a game?

Have you ever been hospitalized overnight or longer? Are you currently ill or have you been ill within the past four weeks?

Have you had any problems with environmental heat or cold illness?

Do you have any history of chest pain, or irregular heart rhythm at rest, during or after exercise?

Do you have any loss or impairment of internal organs?

Do you have a bleeding disorder (anemia, hemophilia)?

Do you think you have problems with your weight or have an eating disorder?

Do you have any history of frequent (more than 3x a week) diarrhea or constipation?

Do you know of any health reason why you should not participate in Grand Canyon Univ. Intercollegiate Athletics at this time?

Have you ever been instructed by a physician to NOT participate in any sport activity?

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Please indicate if you have a history of any of the following:

Yes No Medical Condition:

Yes No Medical Condition:

Yes No Medical Condition:

Seizures Tuberculosis Asthma Hepatitis Mononucleosis Rheumatic fever Abdominal infections Abdominal trauma High blood pressure Diabetes Collapsed lung Arthritis Bronchitis Scarlet fever Heart murmur Pneumonia Thyroid disease Other:

Yes No Question If yes, please explain:

Have you been diagnosed or are you on medication for ADHD (Attention-deficit/hyperactivity disorder)? If so please list medications.

Do you have history of a learning disorder? Do you have Sickle Cell or Sickle Cell Trait

HEAD AND NECK

Yes No Question If yes, please explain:

Have you had any head injury, concussion (loss of consciousness, fainting, knockout, blurred vision, “dinged”) during the past three (3) years?

Do you have abdnormal hearing in either ear or abnormal vision in either eye (including color blindness)?

Do you wear contacts or glasses? Do you have frequent headaches or headaches after exercise (not related to injury)?

Do you have a history of a fracture, injury or pain in the face, jaw, teeth, skull or nose?

Do you have any teeth or gum discomfort, broken or missing teeth, or do you wear a removable dental appliance?

Have you been advised to have any dental (teeth or gum) surgery, procedure (fillings, caps, crowns, etc) that has not been done?

Have you had a hit or blow to the head that caused confusion, prolonged headache, or memory problems?

Number and dates of previous concussions, and number of days missed after a concussion?

Do you have a history of Migraines?

ORTHOPEDIC

Yes No Question If yes, please explain:

Have you ever had a fracture, dislocation, ligamentous, or cartilage injury?

Have you been advised to have any orthopedic surgery (bones, joints, ligaments, cartilage or disc) at any time in your life?

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Please indicate if you have had any of the following:

FAMILY HISTORY

Yes No Question If yes, please explain:

Has any blood relative(s) died before the age of 50 from natural causes (heart disease, cancer, etc) or from unexplained causes?

Please indicate if any blood relative(s) (Mother, Father, Sisters, Brothers, Grandparents…) have had any of the following:

Yes No Medical Condition:

Yes No Medical Condition:

Yes No Medical Condition:

High blood pressure Asthma Cancer Stroke Chronic bronchitis Diabetes Heart attack By-pass surgery Sickle-cell disease Migraine/chronic headaches Kidney disease Skin disorders Drug/alcohol dependency Nerve disorders Intestine disorders Other: Other: Other:

ADDITIONAL FEMALE HISTORY

Yes No Question If yes, please explain:

Have you failed to menstruate for more than three (3) consecutive months?

Do you have irregular cycles: less than 21 days or more than 35 days?

Do you have abnormal menstrual flow: less than 2 days or more than 7 days?

Would you like to speak with a health care professional about women’s health?

Please utilize this space for additional responses to “yes” answers.

Yes No Medical Condition:

Yes No Medical Condition:

Stress fracture Shoulder impingement Chondromalacia Osteomyelitis Osgood-Schlaters Disease Patellar tendinitis “Little league elbow” Achilles tendinitis Shin splints (MTSS) Burner or stinger Rotator cuff tendinitis Other:

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ALL STUDENT-ATHLETES

The undersigned, herewith: A. Understands that he/she must refrain from practice or competition during medical treatment until they are discharged from

treatment or given a written permit by the attending physician to resume participation. B. Certifies that the answers to these questions are true and correct. C. Understands that he/she having passed the physical examination does not necessarily mean that he/she is physically

qualified to engage in athletics, but only that the examiner did not find a medical reason to disqualify him/her. D. Fully realizes that Grand Canyon University cannot be held responsible for any previous conditions that he/she might have. E. Understands permission to participate will not be granted until these forms are completed and signed by the certified

athletic trainer. Student-athlete’s Signature _______________________________________________ Date _________________ If minor: Parent / Guardian Signature _______________________________________ Date _________________ Certified Athletic Trainer’s Signature ________________________________________ Date _________________

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Grand Canyon University Athletic Training

HEAT ACCLIMATION QUESTIONNAIRE

Name _______________________________________Sport _________________________Date___________________

Please answer all questions at least with yes or no answers.

1. Have you ever had any type of heat related problem (heat exhaustion, stroke, cramps, dizziness, fainting, collapse) before?

2. If you answered yes to the above question, how many times did that particular problem occur, when did it happen, and did you seek treatment?

3. Were you on any form of conditioning program during the summer? If the answer is yes, briefly explain your program.

4. Did you work or work-out in an air-conditioned building during the summer?

5. Are you presently on a diet or a vegetarian? If yes, what kind of diet? Who designed it?

6. How often do you intake fluids during exercise? Do you consume sports drinks during exercise?

7. Have you recently (last 2 weeks) had a cold, problem with vomiting, or diarrhea? If yes, please explain.

8. Are you currently on any medication? If yes, list the name and/or purpose of the medication.

NOTICE: If you notice any of the following signs of heat illness, during or after activity, seek attention of athletic trainer immediately: Nausea, Fatigue, Unsteadiness, Weakness, Cramping, Disturbed vision, Decreased sweating, Rapid & weak pulse

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GRAND CANYON UNIVERSITY STUDENT-ATHLETE

ACKNOWLEDGMENT AND CONSENT INFORMATION:

Acknowledgement of Risk and Consent to Participate:

I am aware that the very nature of athletic participation carries with it an inherent risk of injury. I understand that the dangers and risks of participating in athletics, whether in competition or preparing to compete, include, but are not limited to, death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious musculoskeletal injury to virtually all bones, joints, ligaments, muscles, tendons, and other aspects of the muscular skeletal system, and serious injury or impairment to other aspects of my body and general health and well-being. In addition, I am aware that participation in intercollegiate athletics will involve traveling with the team, and that such traveling may expose me to the risks of a motor vehicle accident, as well as other conditions that result from traveling.

Having understood the risks of athletic participation and particularly the risk inherent in the sport listed above, I voluntarily assume and accept these risks as they have been explained above. I realize that the coaching staff, athletic trainer, administrators, and other Grand Canyon University personnel will do those things necessary to reduce the risk of injury. However, I realize and accept that these measures will not prevent all athletic injuries to myself or to other student-athletes. I also accept the responsibility in taking personal measures to help prevent injury to myself or other student-athletes by notifying the coaching staff, athletic trainer, administrators or other Grand Canyon University personnel of conditions that I am aware of that may predispose me or other student-athletes to an increased risk of injury resulting from athletic participation.

CONSENT TO TREAT AND TRANSPORT:

I grant permission to the Director of Health Services, Athletic Trainer or Coaching Staff member from Grand Canyon University to proceed with needed medical and minor surgical treatment, ambulance notification, x-ray and immunization. My signature consents that needed emergency treatment may be given as necessary for the best interest of the student-athlete. In the event that emergency treatment should be necessary, a copy of this permission will be furnished by the physician in charge.

CONSENT TO RELEASE OF MEDICAL INFORMATION:

As a student-athlete at Grand Canyon University, athletically related injuries may require services of a physician or medical treatment facility. I understand that, as a student-athlete, I am required to carry a primary insurance policy (either institutional student insurance or the student-athlete may be covered under their parent/guardian insurance plan.) All claims will be submitted initially to this plan. The university has insurance coverage for student-athletes as a SECONDARY INSURANCE POLICY FOR ATHLETICALLY RELATED INJURIES ONLY. This means that after the primary plan has considered any claims, the University insurance will take over. In the event that a primary policy does not cover intercollegiate athletically related injuries, the University policy becomes the primary policy. Student-athletes are required to provide insurance information in order to participate in intercollegiate athletics. For the University to file for benefits under these policies, the student-athlete (or parent/guardian) must provide copies of all bills and primary coverage explanation of benefits (EOB). These copies must be submitted to the University insurance coordinator in a timely manner to prevent delays resulting in late payment of bills. In signing the signature page, I acknowledge my understanding of this policy and grant permission to the Grand Canyon University athletic training staff and/or insurance coordinator to contact my parents/guardians and pertinent medical facilities to gain information regarding insurance and insurance claims information for athletic injury claims at Grand Canyon University.

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Authorization/Consent for Disclosure of Protected Health Information to the NCAA:

My signature on the signature page indicates my consent for Grand Canyon University and its physicians, athletic trainers and health care personnel to disclose my protected health information and any related information regarding any injury or illness during my training for and participation in intercollegiate athletics to the National Collegiate Athletic Association (NCAA) and its employees or agents.

I understand that my protected health information will be used only by the NCAA’s Injury Surveillance System (ISS) for the purpose of conducting research on injuries resulting from training for or participation in athletics. The ISS is a longitudinal research database that provides the NCAA, NCAA sports rules committees, athletic conferences, researchers and individual schools with summary (aggregate) injury and participation information that does not identify individual athletes or schools. The summary data provide the Association and other groups with an information resource upon which to base health and safety rules and policy and to examine the effectiveness of such efforts.

I understand that my injury/illness information is protected by federal regulations under either the Health Information Portability and Accountability Act (HIPAA) or the Family Educational Rights and Privacy Act of 1974 (the Buckley Amendment) and may not be disclosed without either my authorization under HIPAA or my consent under the Buckley Amendment. I understand that my signing of this authorization/consent is voluntary and that my institution will not condition or withhold any health care treatment or payment, enrollment in a health plan or receipt of any benefits (if applicable) on whether I provide the consent or authorization requested for this disclosure. I also understand that I am not required to sign this authorization/consent in order to be eligible for participation in NCAA athletics.

I understand that while HIPAA regulations do not apply to the NCAA’s use or disclosure of my injury/illness information, the NCAA is committed to protecting my privacy. I understand that the protected health information will be encoded before being transmitted from my institution to the NCAA and that neither the NCAA nor the ISS will identify me personally in any publication or disclosure of research results. Data will be stored on a secure server at the NCAA national office in Indianapolis, Indiana.

This authorization/consent expires 380 days from the date of my signature below, but I have the right to revoke it in writing at any time by sending written notification to the athletics director at my institution. I understand that a revocation takes effect on its request date and does not affect any action taken prior to that date.

Acknowledgement Regarding Athletic Secondary Insurance at GCU:

• Athletic injuries and their costs are, ultimately, the responsibility of the student athlete, not Grand Canyon University (GCU). The University purchases athletic insurance on the students’ behalf, and attempts to assist the student with the filing of claims under that policy. However, compliance with the terms and conditions of the policy is also the ultimate responsibility of the student.

• If the student does not cooperate with the insurance company and follow its rules–or if the company determines that the injury or treatment is not covered under the policy and the patient/student does not pay the medical bill by some other means–the bills may be sent to a collection agency in the name of the patient: that is, the student athlete. The student’s credit rating can be impacted by this non-payment/non-compliance.

• Athletic insurance is secondary insurance. This means that the insurance company will pay only after you have cooperated in providing information / documentation related to your primary insurance. (For example, the insurance company may require an Explanation of Benefits from the primary carrier.)

• Student must see a medical professional for an injury no later than 90 days after an initial injury. • Issues on such things as obtaining a second opinion, treatment outside the plan, pre-existing conditions, what is or is not

an athletic injury, etc. should be directed to the athletic insurance company. GCU personnel cannot answer these questions, but can only assist the student in contacting the carrier for answers.

• Most important: The issue of an athletic injury is between the student athlete and the insurance company. GCU buys the insurance to supplement the students’ primary insurance, and helps the student with forms, etc. BUT, GCU personnel are not insurance agents, experts, or parents AND GCU is not responsible for any medical bills incurred by the student athlete. We care about the student and want to help, but the roles must be kept clear. Signature on the signature page indicates that the Student-Athlete (as well as the holder of the primary health insurance policy under which the student-athlete is covered) has read and understands the above information.

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2016 GCU Intercollegiate Athletics Athletic Training Forms Signature Page

In an effort to reduce redundant paperwork in your student-athlete file in the athletic training room, this document has been created to allow for you to indicate your acknowledgement, consent and acceptance of the policies and/or procedures in the GCU Student-Athlete Acknowledgement and Consent Information pages.

Acknowledgement of Risk and Consent to Participate:

I have read the statement and understand that participating in athletics has inherent risks of possible bodily damage or injury as explained. I voluntarily assume and accept the risk of participating in intercollegiate athletic activities at Grand Canyon University

CONSENT TO TREAT AND TRANSPORT:

I have read the statement and consent that needed emergency treatment may be given as deemed necessary by authorized personnel.

CONSENT TO RELEASE OF MEDICAL INFORMATION:

I have read the statement and acknowledge my understanding of this policy and grant permission to the Grand Canyon University athletic training staff and/or insurance coordinator to contact my parents/guardians and pertinent medical facilities to gain information regarding insurance and insurance claims information for athletic injury claims at Grand Canyon University.

Authorization/Consent for Disclosure of Protected Health Information to the NCAA:

I have read the statement and consent for Grand Canyon University and its physicians, athletic trainers and health care personnel to disclose my protected health information and any related information regarding any injury or illness during my training for and participation in intercollegiate athletics to the National Collegiate Athletic Association (NCAA) and its employees or agents.

Acknowledgement Regarding Athletic Secondary Insurance at GCU:

I (as well as the holder of the primary health insurance policy under which the student-athlete is covered) have read the statement and understand the stated information regarding GCU’s Secondary Athletic Related Insurance coverage.

Student Name: Sport:

Signature: Date Signed:

If Student Athlete is a Minor (not yet 18 years of age) Parent/Legal Guardian must also sign below

Parent: Date Signed:

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WAIVER AND RELEASE FROM LIABILITY

I recognize and expressly agree that participating in any sport or activity associated with athletics is an inherently dangerous activity. Further, I recognize that certain safety precautions must be followed, yet even strict adherence to those procedures does not guarantee nor does Grand Canyon University guarantee Participant’s Safety.

Waiver and Release from Liability: In consideration of permission to use, today and on all future dates, the property, facilities, staff, equipment and services of GRAND CANYON UNIVERSITY. I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue The Grand Canyon University, its directors, officers, employees and agents from liability from any and all claims including the negligence of Grand Canyon University, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participating in activities, classes, observation, and use of facilities, premises, or equipment.

Assumption of Risks: Physical activity, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. GRAND CANYON UNIVERSITY has facilities for and provides for activities such as weight lifting, running, aerobic activities, classes and sporting activities. Some of these involve strenuous exertions of strength using various muscle groups, some involve quick movements involving speed and change of directions, and others involve sustained physical activity which places stress on the cardiovascular system.

The specific risk vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains to 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions to 3) catastrophic injuries including paralysis and death.

I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in the activities made possible by GRAND CANYON UNIVERSITY. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.

Publicity: I understand that on occasion, GRAND CANYON UNIVERSITY takes photographs or makes audio or video tape recording of children and/or adults involved in camp activities. Such photographs and audio/visual recordings may be used in the Grand Canyon university publications, promotional materials and pertinent website. I understand that such contemplated photos will have no addresses or identifications of any sort on such photos and are considered the property of Grand Canyon University and may not be sold or reused. I agree to the use of any such audio or visual recording to be used, distributed as administrators of Grand Canyon University see fit. This consent includes but is not limited to: photographs videotape, and audio recordings

Indemnification and Hold harmless: I also agree to INDEMNIFY AND HOLD Grand Canyon University and its Board of Directors, HARMLESS from any all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement at Grand Canyon University, and to reimburse them for any such expenses incurred.

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of Arizona and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Acknowledgement of Understanding: I have read this Waiver and Release of Liability and fully understand in terms, and understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

____________________________________________ ___________________________________________ Printed Name of Participant Printed Name of Guardian (if participant is under 18) X ________________________________/__________ X _____________________________/___________ Signature of Participant / Date Signature of Guardian (if participant is under 18) / Date

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GCU DANCERS TRYOUT ACKNOWLEDGEMENT & ACCEPTANCE

I have carefully read and understand all content of the Grand Canyon University 2016-2017 Dancers Tryout Packet.

I certify that my information in this packet is true and accurate to the best of my knowledge.

I understand and accept the judging panel’s decision for the 2016-2017 GCU Dance Team as final.

I agree that should I be selected for the 2016-2017 GCU Dance Team I will commit and fulfill all requirements of GCU Dancers. I also agree that if I am selected for the 2016-2017 GCU Dance Team and do not fulfill all requirements, I will be responsible for reimbursing the program for any financial loss, including the cost of camp, travel expenses, and apparel. I, ________________________________________, agree to the conditions stated above. Printed Name _________________________________________ _______________________________ Signature of Applicant Date

_________________________________________ Signature of Guardian (if candidate is under 18) _________________________________________ _______________________________ Print Name Date