March 2017

PENINSULA CHEER Dear Parents & Cheerleading Candidates, Thank you for your interest in the Palos Verdes Peninsula Cheer Team and Spirit Program. We hope you enjoy your tryout experience and are able to learn more about cheerleading along the way. Whether you are new to the cheer or a seasoned veteran, being part of the Cheer Team and Spirit Program here at PVPHS will bring each member experiences and memories, both on and off the field that will last a lifetime! Our tryout process is designed to allow individuals the opportunity to grow, learn, and showcase their individual strengths. We especially love working with new athletes, helping them discover their talents and developing a love for Cheer. In this packet you will find information about our Cheer Team and important dates. This packet outlines our program in detail and was designed to answer many of the questions we know you may have, including: Tryout Information Important Dates Registration & Waiver Form Candidate Questionnaire Student Grade Check Form Signed Student Agreement Signed Parent Agreement Frequently Asked Questions Tryout Tips Spirit Program Contract

TRY OUT INFORMATION

General Requirements • Read through Cheer Tryout Packet thoroughly with your Parents. • Review the Important Dates. Attendance for all dates listed is MANDATORY! If there are scheduling

conflicts that cannot be rescheduled, you will not be able to tryout. If scheduling conflicts arise after tryouts, including but not limited to vacations, you may be suspended from the squad.

• Complete and turn in the following forms by Monday, MARCH 27TH 2017 The first day of cheer clinic - Candidate Questionnaire - Student Grade Check (please get this form to your teachers ASAP) - Student Signed Agreement - Parent Signed Agreement - Peninsula High School | Cheer Program Contract - Current Photo

Squad Eligibility 2017-2018 School Year

Seniors: All incoming Seniors will be considered for the Varsity squads ONLY. Juniors: All incoming Juniors will be considered for the JV and/or Varsity squads. Sophomores: All incoming Sophomores will be considered for the JV squads. However, Sophomores

may also be eligible for placement on the Varsity squad at the coaches’ discretion. Freshmen: All incoming Freshmen will be considered for the JV squad ONLY.

Appropriate Clinic and tryout Attire:

- Fitted black gold or white T-shirt or Tank Top (no logos)

- Black Shorts

- Sneakers or Cheer Shoes

Completed & Signed Tryout Forms:

- Registration/Waiver Form

- Student Grade Check

- Candidate Questionnaire

Water Bottle

Hair should be pulled back neatly into a single High Ponytail

No jewelry or colored or acrylic nails

Tryout Results Results will be announced within 72 hours of the tryout date

Coaches’ decisions are final and will not be open for discussion

Can I tryout even if I don’t have any Cheer or Dance experience? Absolutely! Each year many of the girls who make the team have never been part of a Cheer Team before. We love working with athletes who are new to the activity. Do you have to know how to tumble to make the Cheer Team? Absolutely not. Tumbling is not a mandatory requirement for Cheer; however, it does add to your overall tryout score. Most of our athletes started with very little or no tumbling experience .Peninsula Cheer provides several opportunities for our athletes to work on their tumbling skills, no matter their current skill or experience level. If you would like a recommendation for Tumbling Instruction, please contact us. What is the time commitment? Can I do another team or activity at the same time? The PVPHS Cheer Team is a year round sport at Peninsula High School Our teams begin practices in April immediately following tryouts, and continue until April of the following year. The Cheer Team cheers for Football in the Fall, Boys’ & Girls’ Basketball in the Winter, and all CIF Playoff games. Our teams will begin to participate in local and regional Cheer Competitions in the Winter and Spring if schedule permits. If a team member wants to participate in another activity or sports program (whether on campus or off-campus), participation cannot negatively impact their responsibilities to the PVPHS Cheer Program. If a scheduling conflict arises, your responsibilities to the Cheer program must come first. Is there practice over the summer? Will I be able to go on vacation with my family? Summer practices and Camps/Clinics are mandatory. This is when you will learn and perfect the necessary game material for the bulk of the year. Please check the “Important Dates” section of the Tryout Packet to ensure there are no potential conflicts. There will be two extended breaks during the summer. Please try to schedule vacations and trips during these times. We will also attend several Camps and Clinics throughout the Spring and Summer. Some of the best times of the season are away at camp. We work hard, play hard, and bond as a team. I just got a new piercing. Do I really have to take it out? YES. We do not allow jewelry of any kind at any practice, game, performance, or event. It must be removed. Taping over piercings is not an option. What if I have a question that isn’t answered in this Packet? Please feel free to call Kim Stoneman 310-210-9448 or email at stonemank@pvpusd.net . We will be happy to answer any question you may have.

2017-2018 Tryout Tips Are you a Cheer newbie? Or maybe you’ve been cheering and/or dancing for a while and just need a crash course in

Tryouts 101? If you’re nervous about tryouts, check out these ten terrific tips for tryouts!

1. The most important element of your appearance is your attitude!! Smile genuinely. Relax, be yourself, and have fun out there. Be confident and carry yourself with poise. Also, be attentive to the coaches’ instructions and make eye contact as much as possible.

2. Make smart clothing choices. Wear

clothing that fits. Baggy clothes look sloppy, and you don’t want to be constantly adjusting for an outfit that is too tight. Check the Tryout Information Sheet for specifics on clothing and hair. And remember, absolutely no jewelry of any kind.

3. Get your beauty sleep. The night before

tryouts, get a good night’s sleep. Be sure to have a healthy breakfast and lunch the day of. You don’t want to be or look exhausted.

4. During the tryout, take your time. Don’t

feel the need to rush. Take one element at a time rather than thinking about the whole tryout at once. Don’t worry about trying to remember the cheer while you’re doing your toe touch. Take deep breaths and remind yourself that you can do it.

5. If you make a mistake, don’t worry. Keep

going. Try not to giggle, get frustrated, or upset. Everyone makes mistakes, and how well you handle it will reflect on your ability to deal with setbacks. The coaching staff isn’t looking for perfection. They want to see you give it your best.

6. Be loud, without screaming. Enunciate

each word loud and clear so you can be understood. When showing spirit or “hitting your crowd” choose phrases like “Let’s Go

Panthers “Go Black and Gold”, “Fight Peninsula Fight.” Avoid “woo hooing.”

7. During the Tryout Clinics, try to make

new friends. Pair up with someone to work with throughout the Tryout Week. You will be able to help each other remember the tryout material and critique each other on your motions and jumps. You can provide each other with encouragement, and having a friend on tryout day will help make the day less scary!

8. Practice cheers, chants, and dances in

front of a mirror to make sure your motion placement is correct while the material is fresh in your mind. Clean up your jumps techniques, by practicing sharpening your motions, pointing your toes, and sticking your landing.

9. Don’t try anything you are not

comfortable doing, especially in regards to tumbling. The last thing the coaches’ want is for someone to get hurt. If you are unsure of your ability to do a back handspring at tryouts, don’t force it. Stick to what you are confident with and you will do well. Remember the coaches are looking for confidence and potential as well as current ability.

10. Work hard and take advantage of the

advice of the coaches’ and Spirit Squad members teaching the tryout material and running the clinic. If you are new to cheerleading, be open to trying new things. The coaching staff will be evaluating your attitude and work ethic during the week. The best cheerleaders are versatile and know how to work well with others.

IMPORTANT DATES

Monday through Thursday March 27th-30th Cheer Clinic and Tryouts 3:30-5:30pm 3:30-6:00pm on the 30th Location: PVPHS Field House You must attend all days. Tuesday April 11th Parent and Cheerleader Orientation Meeting 6:00-7:00pm This is a mandatory meeting for all of our 2017-2018 Cheer Team Members & Parents. Cheer summer and season Payment due this day April 15th Uniform fitting, cheer gear sizing Mandatory!!!!! Time and place TBD Monday April 17th Practices begin for new team 4-6pm Monday Tuesday and Wednesdays through to June5th We will learn band routines, sideline cheers , halftime and side line dances for football season. Stunt and condition. July 31st August 1 and 2nd In Home Cheer Camp with TSC 8am to 5pm all three days in the Gym and dance rooms Monday August 7th 4-6pm Mondays Tuesdays and Wednesdays until school starts Back to School schedule Monday and Wednesdays practices either 2-4pm or 3-5pm Football games will start right away JV on Thursdays and varsity on Fridays

Spirit Program Contract

I, as a member of the Peninsula High School Cheer Team, I am dedicated to the total support of the school and its programs. I acknowledge and accept that as a member of the PVPHS Cheer Team, a highly visible campus organization, I am a representative of my High School and the community. I will accept the responsibilities and leadership obligation, which are a significant part of the Cheer Program and the entire PVPHS Spirit Program that is cheer, song, flag and mascot. . As a result, I accept that standards for my behavior and performance will often have to meet standards and guidelines above those expected of the general student body.

General Information Section I Purpose

The primary purpose of the Spirit Program is to support the athletic programs at Peninsula High School while developing and maintaining school spirit. In addition to our responsibility to the Athletics Programs, we also participate in local, regional, and national competitions, fundraisers, and community events. These events are mandatory. The Spirit Squad takes pride in its role as ambassadors and Student Leaders of our school and the community through our activities. We strive to represent ourselves, our school and community to the highest standard through good behavior and sportsmanship at all times.

Section II Membership & Eligibility

All athletes must audition for a position on the Cheer Team each season. Tryouts are held early Spring for the following School Year. Returning member must also audition, and will be assessed on previous years’ performance, work habits, and attitude by the coaching staff. All Cheer Team members are required to maintain a minimum 2.0 Grade Point Average (GPA) with no F’s or U’s in citizenship in order to be eligible for participation.

Grades will be checked at each quarter. If a member’s GPA falls below a 2.0 or includes any

F’s or U’s in citizenship, the member will be placed on academic probation for four (4) weeks. During this time she may not wear her uniform nor participate in any school activities as a cheerleader. She/He will still be required to attend all practices and games and know all cheers and routines.

At the end of the probation period, a special progress report will be issued to determine future

eligibility. If a member’s grades have not been elevated to meet the minimum requirements, the team member will be dismissed from the squad. If the team member is able to raise their grades to become academically eligible for participation, they will be reinstated to participate in activities as a cheerleader. If a team member’s grades fall below the minimum requirements a second time (at any point during the same Academic Year), they will be dismissed from the squad. Academic probation is your second chance opportunity. There will not be another.

Section III Physical Education Class- 6th Period Spirit Squad All Cheer Team members are required to take Cheer as a 6th period PE Class, during the

school year. If the member is dropped from the squad at any time, for any reason, she may receive an “F” in Cheer class as a result, in accordance with school grading policy.

Grades for 6th Period Cheer Class are given based on a Point System. Points are awarded for

attendance, following all rules, turning in paperwork and fundraising money on time, etc. Total possible points are added and the grading scale is then determined. Each Spirit Squad member’s grade is determined by the number of points they earn. (See student handbook for grading scale)

The following will affect the student’s grade and may be cause for immediate and just

discipline according to the severity of problem: a.) not meeting squad participation hours b.) insufficient knowledge of game and performance material c.) not wearing a clean uniform free of damage (i.e. holes) d.) gum chewing at practices or while in uniform e.) eating on the field or courts during a game or performance f.) wearing jewelry at practice or while in uniform g.) not wearing the assigned uniform in its entirety h.) not wearing proper practice attire i.) excessive talking during games, performances, and/or practices j.) arriving late to practices, games, and/or performances k.) turning in paperwork or required materials late. l.) unexcused absences from practices, games, and/or performances

If a team member is dismissed from or quits the squad prior to the end of the grading period,

their final grade will be determined by the total points earned. The grading scale based on the total points possible for the grading period will not be adjusted or modified.

Section IV Athletic Department Packet & Physical All members must have the physical capability required to participate safely as an active team

member. All members must have a Health Exam (time to be valid for the entire year) and submit proper paperwork to the School Office by the given deadline. Packets are available for download on the home page of the PVPHS School website each year.

Duties, Responsibilities & Time Commitment

Being a member of the Peninsula High School Cheer Team requires a YEARLONG

commitment. All members must maintain flexibility in their individual schedules as events, performances, or games may be scheduled with minimal notice (i.e. CIF Playoffs, community events, Fundraising opportunities). The PVPHS Cheer Program requires a 13-month commitment as the season begins in April immediately following tryouts and continues through April of the following year!

Section I Practice Members are required to attend weekly practice from approximately 2 hours in length 2 times

per week plus games during football and basketball seasons. Additional or longer practices may be called at times. Jobs, vacations and doctor appointments are not excused absences. Repeated unexcused absences will affect grade and may result in disciplinary action. Practices may be cut short/cancelled without advanced notification.

Section II Games and Performances Members are required to attend all assigned games, including CIF Playoffs, as scheduled by

the Coaching Staff. These games are MANDATORY. The Cheer Team will cheer and perform for Football, Boys’ & Girls’ Basketball (Winter), and lend their support to other sports teams by attending (but not performing) those games. CIF Playoff Games are on a game-by-game basis and require scheduling flexibility on the part of all Cheerleaders during these time periods, including during Thanksgiving Break. Participation in all practices, games (including CIF playoffs) and performances is mandatory. Designated uniforms to be worn will be determined and announced at the prior day’s practice. All team members must wear the designated uniform in its entirety, without exception. Anyone missing any part of their uniform may not be permitted to participate in the Team Performance or Activity, but must remain present at the activity for its duration. (This includes Cheer Shoes, Poms, etc.) Hair is to be pulled back neatly off the face and shoulders in high pony with bow all times while in Uniform. Hair may be worn half up/half down to school (but not at games) with coaches’ approval.

Section III Competitions If we choose to compete there will be additional practices that will occur and each cheerleader will be responsible for attending these additional practices for competition. There are costs associated with participating in competition and those costs are the responsibility of each individual family. There are fundraising opportunities available to help offset those expenses. Any decisions related to competition participation will be made by the coaching staff to serve the best interests of the overall program. The number of competition squad members may change at any time if deemed necessary. Participating in competitions may not in any way interfere with primary purpose of the Cheer Team, which is to serve our High School. Our obligation to the school comes first.

Section IV Community Service & Events Throughout the year, attendance at local community events may be required. The PVPHS

Cheer Team serves as ambassadors of Palos Verdes and the community takes great pride and pleasure in celebrating the talents and accomplishments of our teams. It is our pleasure to enhance local events with our participation and performances.

Fundraising: All team members are required to participate in fundraising activities

throughout the year to help offset the general program expenses which include transportation, equipment, coaches’ salaries, etc. Event participation varies based on the type and needs of each event. We provide a calendar of dates as soon as possible to aid families in their planning. Any and all money collected for fundraising events must be turned in on-time.

Possible Fundraising Examples: selling ads in the PVPHS Football program, tree and wreath

sales in cooperation with PVPHS Baseball team, working cheer clinic in the fall and spring All members are expected to participate in all fundraising efforts throughout the season.

Athlete Expectations & Responsibilities Section I Attendance

Attendance is mandatory at any cheerleading game, performances and event (including fundraisers and competition). All athletes are expected to arrive on time to all practices, meetings, games, fundraisers, pep rallies, and events. Repeated failure to attend practices will affect grade and may result in disciplinary action. Absences due to jobs, vacations, detentions, personal matters, and/or regular medical appointments are not excused. Any athlete who misses practices the day before a game or schedule performance may be removed from the routine and not permitted to perform. The decision to place that individual back into any choreography is at the coaches’ discretion based on the best interest of the team performance.

Section II Conduct & Professionalism

• Use of profanity during practice, performance, or event is prohibited, especially when in Uniform. Your representation of the PVPHS Cheer Team and Spirit Program should always be respected in high regard.

• Smoking, drinking alcoholic beverages, and/or use of illegal drugs AT ANY TIME is cause for immediate dismissal from the PVPHS Cheer Team.

• Unnecessary socializing and/or talking with fans, friends, or other Cheerleaders during games, practices, or performances is prohibited.

• Conduct unbecoming of a Cheer Team member (in or out of uniform) may result in disciplinary action at the coaching staff’s discretion.

• If for any reason the coaching staff feels that a team member is not upholding the Code of Conduct & Professionalism required of a team member, they reserved the right to suspend that team member pending consultation with their parents.

• Members will abide by all rules and regulations at all times. Members will also respect all decisions and actions of the coaching staff as communicated directly or via the Team Captains (whether they are agreed or not). Questions or concerns may be addressed directly to the coaching staff appropriately and privately.

• Any type or form of disrespectful behavior towards Team Captains, other squad members, competitors, coaches, or other adult supervisors is unacceptable. This includes “back-talking” and/or sarcastic comments and behaviors. Criticizing other squad members will not be tolerated. There is no room for negative attitudes in the

PVPHS Spirit Program. Attitude problems will be dealt with appropriately and immediately.

• Should a squad member choose to host or participate in any social networking sites, any content and behavior must be in accordance with the Cheer and school conduct guidelines. This includes postings, photographs (whether posted by you or others), and video. Participation in any inappropriate behavior (including bullying) may result in disciplinary action by the coaching staff and School Administration.

• Stunting and/or Tumbling is not allowed at any time unless a coach or qualified adult appointed by the coaching staff is present. Unsafe horseplay (especially during stunting or tumbling activities) at any time is prohibited.

Section III Skill Development & Training (Skill Assessment, Tumbling)

Being on the Cheer Team involves many physical elements, all team members are required to stay in good physical condition for safe participation throughout the year. Each athlete is required to participate in a training program that will include Flexibility, Stunting, Tumbling, and Dance training. Coaches will periodically assess the skill levels of all athletes and maintain safe and proper progressive training to advance those skills.

All athletes will be required to participate in supplemental training (tumbling classes) at least

once a week as part of their regular team practice commitment. Supplemental training may take place at school during regular practice hours and offsite as a regularly scheduled team class as deemed necessary by the coaching staff.

All coaches and team members are required to follow the safety guidelines of the American

Association of Cheerleading Coaches and Administrators (AACCA) and the National Federation of High Schools.

Section IV Disciplinary Action

Examples of disciplinary actions that may be taken for misconduct or rule violations are as follows (in no particular order): a.) Verbal warning b.) Written notice sent home c.) Game/Performance Benching d.) Parent Conference e.) Suspension f.) Dismissal (removal from the team)

Uniforms & Appearance

Section I Uniform Care & Use

All Team members must be dressed alike during games, performances, competitions and other squad events. The assigned “What To Wear” for School Days, Practices and events will be given out in advance and must be followed by all in order to participate. The Team Captains and/or Coaching Staff will determine the attire to be worn.

Uniforms must be maintained and worn in a clean, neat, and orderly fashion at all times. Due to their constant wear and tear, shoes must be clean often. Replacement items are the

responsibility of each team member as necessary due to damage, staining, or substantial wear and tear. Uniforms, Sweats, and Practice Clothing are to be worn by current members of the Spirit Program only. Items may only be worn in conjunction with participation in a Cheer Team Activity, unless prior approval is obtained from the coach. Uniforms may also only be worn in their entirety, including Hair and Shoes. For example, no Game Uniform and UGG Boots/Flip Flops or Warm Up Jacket with School Clothing. The Cheer Uniforms are just that, Uniforms, not opportunities for individual fashion statements. Please respect that. Anyone missing any part of their uniform may not be permitted to participate in the Team Performance or Activity, but must remain present at the activity for its duration. (This includes Cheer Shoes, bow, Poms, etc.)

Section II Jewelry, Nail, and Hair Care

All jewelry must be REMOVED prior to the start of practice and while in uniform. This includes, but is not limited to, all earrings, bracelets, necklaces, body piercings, and rings. Nails should be neatly manicured and at a short length, to avoid accidental injury to another squad member or themselves. This includes acrylic and similar applications. All nails should be free of ANY colored nail polish or design (with the exception of a nude, white French tip, black, gold or white nicely polished nails). When in doubt, ask a coach. Hair is to be pulled back neatly off the face and shoulders in high pony tail with bow front facing at all times while in uniform. Hair may be worn half up/half down with coaches’ approval. Hair should be neatly styled at all times. No messy buns, bed hair, loose ponytails, or loose braids. Squad members are also prohibited from having extreme hair colors whether dyed or colored extensions, in their hair. When in doubt, ask a coach. Such styles are a distraction from the uniformity of the team and the overall performance.

Section III Practice Attire

Proper attire (T-shirt, Athletic Tank, shorts or sweats, socks, and cheer shoes) must be worn to all practices. All clothing, including Sweatshirts, should be plain colored and free of logos. Exception School/Team, Cheer Team Spaghetti strap tops, jeans, sandals, bare feet, excessively baggy or loose fitting clothing items are not permitted. Hair must be pulled up and back completely off the face securely fastened with ponytail holders. Bangs and loose hair need to be secured with clips and/or bobby pins. No jewelry is to be worn to practices, performances, or competitions (including all body piercing). Nails should be kept clipped to the length of the finger. These guidelines have been put into place for the safety of our athletes and coaching staff and will be enforced.

Performance, Practice and Transportation Protocol

Section I Practices All members are expected to arrive on-time, dressed properly, ready to fully participate in all

practice activities. Any illnesses, injuries, or limitations to full participation in practice activities must be accompanied by a written note from a parent or doctor. Limitations lasting three (3) or more days must be accompanied by a doctor’s note. If at any time an athlete’s activities are restricted by their doctor’s orders, a clearance note from the doctor is required before the athlete will be permitted to resume fully participation. In the interim, they must continue to attend practice as usual following all rules, including dressing out and being present for the duration practice.

PVPHS Cheer Team members are personally responsible for knowing the dates, times,

required attire, and material for all events. If a team member misses practice for any reason, they are solely responsible for finding out what information they missed and material they need to learn. EACH CHEERLEADER NEEDS TO GET UP-TO-DATE INFORMATION WHEN THEY ARE ABSENT BEFORE THEY RETURN TO PRACTICE.

Section II Transportation All members are required to ride the school transportation (when provided) to games and

events. Any alternative modes of transportation to and from an event must be pre-approved by the coaching staff with a signed note from the team member’s parent granting their permission and waiving liability.

Members will be personally responsible for securing transportation to events when there is no

school transportation provided. DISTRICT POLICY STATES THAT STUDENTS ARE NOT ALLOWED UNDER ANY CIRCUMSTANCES TO DRIVE OTHER STUDENTS. Please keep this in mind when making transportation arrangements.

2017-18 Peninsula Cheer Team for Year Round Sport Summer expense for returning and new team members 400.00 per girl (separate check made out to PVPHS CHEER ) Returning Team Member expense 1200.00 Camp—in house with TSC Cheer Gear (for practices, camp etc for the year, embroidery) ((tops, bottoms, shoes, track suit, bag)) Music (for routines cut and paid for) Media (banners, programs ads, yearbook, signs football and basketball) Team Snacks and dinners Spirit items (for football games, basketball games, homecoming, assemblies, pep rallies, holiday) Senior Recognition football and basketball (crowns, sashes, banner) End of year banquet (venue, décor, certificates, plaques, awards, flowers, pins, senior frame gift, cheer gifts, helper gifts) *Add 18.00 if you do not already have a pink out jersey or need a new one **Optional letterman’s jacket add 360.00 Checks Made out to PVPHS CHEER New Team Member expense 1575.00 In addition to the above list add: Uniform (skirt, shell, liner, embroidery) Ladder (to stand on for football) (team member will paint and decorate) Pom Poms Pink out jersey (breast cancer awareness game and assembly) *Optional Letterman Jacket add 360.00 ****In addition to the cheer expenses that cover our year round season, there is a participation donation of 250.00 made payable to PVPHS, which covers our transportation during football and basketball. Please put Cheer participation donation and your name in the memo area of this check as it goes in a separate account just for our transportation. This check should be turned into the student store at Peninsula HS at the time you go through athletic clearance with the paperwork needed.

PVPHS CHEER TEAM

Athlete’s Full Name _________________________________________ Grade _______ Date of Birth _______________ Home Address ___________________________________________ City _______________ Zip _______________ Home Phone ___________________________________ Athlete Email ____________________________________ Mother’s Name ___________________________________________ Day Phone ________________________________ Father’s Name ____________________________________________ Day Phone ________________________________ Mother’s Email ______________________________________ Father’s Email ___________________________________ Appearance Agreement: I understand that PVPHS Cheer Team in cooperation with our Spirit Program from time to time produces promotional materials relating to its programs. I understand that as a participant in and/or spectator at Spirit Squad events, my child may be included in videotapes or photographs taken during the course of their membership in the Cheer team and Spirit Program. Therefore, without reservation or limitations, I, on my own behalf and on behalf of my child, hereby assign, transfer, and grant to the PVPHS Cheer Team, their successors, assignees, licensees, sponsors, and television networks, and all other commercial exhibitors in advertising and promoting the program or in advertising and promoting similar future events.

Emergency Information Emergency Contact Person _____________________________________ Day Phone _________________________ Health Insurance Carrier _________________________________ Policy No. ______________________________ Medical Conditions (which may affect participation) _______________________________________________________ Current Medications _____________________________________ Allergies _________________________________

My child and I have read, understand, and agree to abide by the rules, regulations, and guidelines of the MCHS Cheer Program as outlines in the Cheer Tryout Packet and Reference Guide.

RELEASE OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

I, the undersigned parent or guardian, do hereby grant permission for my child, ___________________________________, to participate in the athletic activity of cheerleading at Peninsula High School. I understand that this activity involves risk to the participant. I further acknowledge and understand that due to the nature of this activity, which involves inversion and rotation of the body, there is a possibility and risk that my child may sustain physical illness, injury, paralysis, or death in connection with her participation. I further acknowledge and understand that my child is assuming the risk of the same by his/her participation in this activity. I understand that the PVPHS Cheer Team and Spirit Program has established rules and regulations pertaining to conduct, behavior, safety, and participation by which my child must abide. Based thereon, my child and I release and forever discharge Palos Verdes Peninsula High School, its coaching staff, representatives, employees, volunteers, and agents from any and all claims, losses, liabilities, demands, or actions for any illness, injury, or death that my child sustains during participation in this activity. I have read the RELEASE OF LIABILITY, ASSUMPTION OF RISK, & INDEMNITY, understand that my child and I have given up substantial rights by signing it, and have signed it freely without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect. Further, I hereby give permission for certified and licensed medical personnel to use appropriate procedures to aid my child, and to prevent further injury and/or death. If possible, I wish to be contacted before any procedures are initiated; however, if the injuries are catastrophic, life threatening, or I am unable to be reached, I give permission to the emergency care physicians, support personnel, and PVPHS Cheer Team and Spirit Program to do what they deem necessary in the best interests of my child.

Athlete Signature _______________________________________________________ Date ________________ Parent Signature ________________________________________________________ Date ________________

CANDIDATE QUESTIONAIRE

Candidate Name ___________________________________ ’17-‘18 Grade Level ______ 1.) Why would you like to become a Cheerleader? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2.) Please list any previous Cheer, Dance, and/or Tumbling experience you have had, if any. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3.) If you had to describe yourself in only three words, what would they be? ______________________________________________________________________________ 4.) How do you feel School Spirit is perceived at our school and what do you think, as a squad member, you could do to uphold or improve upon that perception? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 5.) What are your biggest strengths? What areas would you like to improve upon? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

***To Be Completed By Coaching Staff***

Overall GPA _____________ Coach Approval _______________________ Tryout Number ___________

Cheer Team Grade Check Student’s Name _____________________________ Current School __________________________ Grade Level ______

- You Must Have a 2.0 or above in order to tryout. - You May Not Have Any F’s or U’s.

Period Subject Grade/Citizenship Please Comment On The Following Areas: Leadership/Responsibility/Areas For Improvement

Initials

This form must be turned in completed with Tryout Packet. Incomplete Forms will not be accepted.

Student’s Signature ___________________________________ Parent’s Signature ______________________________________

*Attach Picture Here

PVPHS TRYOUT APPLICATION (Please Type or Print)

Applicant Information:

Name Birthdate Current School Attending Current Grade GPA Address City Home Phone # Student’s Cell # Student’s Email

Mother/Guardian Name Work # Cell # Father/Guardian Name Work # Cell # Parent’s Email

Tryout Information: I am trying out for: (Please check)

Cheer Song Pep Flags Choreo Company Advanced Dance Intermediate Dance

Varsity Dance Colorguard

Coed Choreo Willing to be a Coed Choreo JV

List any other activities or sports you are planning on participating in for the 2017-18 season

Medical Information: Medical problems: (please check)

Back injury Broken Bones Surgery Knee Injury Ankle Injury Asthma Allergies Neck Injury Other:

Explain:

Parent/Student Commitment Acknowledgement:

1) We have read and understand the TEAM COMMITMENT associated with the performance team my son/daughter haschosen to tryout for (both summer and school year).

2) We have read and understand the RULES for attendance, class grading system, performances, and personal conduct.3) We have read and understand the FINANCIAL EXPENSES that are associated with participation with in performance

team.4) IMPORTANT: any team member who tries out and makes the performance team will be responsible for ALL financial and

team commitments, even if he or she chooses at some point NOT to participate or is dropped from the team. Classcredit will be received only if a student fulfills the entire year of team commitment as outlined.

5) We have read and understand the workshops, tryout information and tryout procedure, judging and scoring procedurerelated to PVPHS tryouts for these performance teams and accept all judges’ decisions as final.

6) We understand and consent to the videotaping and photographing of the student in a school-related activity.7) WE ACKNOWLEDGE THAT WE, THE PARENTS AND STUDENT, UNDERSTAND AND ACCEPT RESPONSIBILITY FOR

ALL COMMITMENTS ASSOCIATED WITH THE PERFORMANCE TEAM HE/SHE HAS CHOSEN, AND GIVE OUR CHILDPERMISSION TO TRYOUT.

Parent’s Signature Date

Student’s Signature Date (rev. 2/2/17)

Attach: *copy of first semester report card*physical examination report

F-1223 Rev. 10/02, 6/10, 3/11, 6/12,10/14

PALOS VERDES PENINSULA UNIFIED SCHOOL DISTRICT Health Services

PHYSICAL EXAMINATION REPORT

**PLEASE RETURN ORIGINAL FORM TO THE SCHOOL. NO COPIES.**

Student’s Name___________________________________Birthdate_______________

Student’s Grade_________________

A physical examination of this student was performed on (Date)___________________.

He/she is physically fit to participate in all athletics.*

Date_____________________ ___________________________________________ Physician’s Signature

VALID ONLY WITH PHYSICIAN’S STAMP

Telephone:__________________________________

* California Interscholastic Federation (CIF) policy 308 states . . . “schools will requirethat a student receive an annual physical examination conducted by a medicalpractitioner certifying that the student is physically fit to participate in athletics. . . .The physical examination must be completed before a student may try out, practice orparticipate in interscholastic athletic competition…”

PVPUSD accepts physical examination reports from a M.D., D.O., Physicians’ Assistant, and Nurse practitioner with a MD’s stamp.

PALOS VERDES PENINSULA UNIFIED SCHOOL DISTRICT Sport/Activity

HIGH SCHOOL SPORT / ACTIVITY CLEARANCE Coach/Advisor

Level (V/JV/10/9)

PRINT NAME (use ink) LAST FIRST MIDDLE

Grade Birthdate Age Student Cell #

Student Email

** I hereby give my permission for the administration of emergency first aid to the above student and approval for his/her participation in the above sport/activity. **

x PRINT NAME – PARENT/GUARDIAN SIGNATURE - PARENT/GUARDIAN DATE SIGNED

CLEARANCE PROCEDURE:

Health Office (Physical Form) Physical Expires Initials Date Signed

Student Store (Athletic/Activity Report, Insurance, Code of Conduct, Waiver (F-603), Voluntary Participation Donation, Initials Date Signed Concussion form, if applicable)

NOTE: A new card must be completed for each sport or activity. Student may not participate until this card has been completed and turned in.

EMERGENCY INFORMATION ON BACK

PARENTS: This information is necessary in the event injury occurs while away from school or outside regular school hours. Please be as specific as possible.

Student Full Name

Home Address

Mother / Father Name(s)

Parent Email Where Mother may Home be reached - Phone Wk # Cell # Where Father may Home be reached - Phone Wk # Cell # Contact if neither Mother nor Father can be reached - Name

Contact Phone Work # Cell #

Doctor Phone

Hospital Phone

CHECK ONE: SCHOOL INSURANCE PRIVATE INSURANCE Name – Insurance Company

History or Allergies, Injuries, Heart, or Other Medical Problems:

F-601 (8/15)

Palos Verdes Peninsula Unified School District

Athletic/Activity Report

(Forgery of these forms will result in disciplinary action by the Associate Principal)

______________________________________________________________________________________Last Name (print) First Name (print) Grade Boy/Girl Sport

_______________________________________________________________________________________Address City/Zip Code Home Telephone Number

_______________________________________________________________________________________Age Birthdate Month and year started ninth grade

_______________________________________________________________________________________Did you transfer from another high school? If so, what date? List name, city, and state of the high school that you

transferred from.

Insurance RequirementsCalifornia Law (Education Code §§ 32220-32224) requires every member of an athletic team to have at least$1,500 medical and hospital coverage.

I ALREADY HAVE INSURANCE for my son/daughter which meets the requirements of CaliforniaLaw. The name of my insurance company is __________________________________________and the policy number is ______________________. I will promptly notify the school in theevent insurance coverage no longer applies to my son/daughter.

School InsuranceMyers/Stevens Insurance Company

I am purchasing Myers/Stevens insurance and returning the Myers/Stevens envelope with the Athletic Packetso the school can send it to the company. I am purchasing the following coverage: (check the appropriatecoverage.)

_____ Tackle Football (covers only tackle football) _____ School Time Low Med High

_____ Full Time Low Med High _____ Full Time Low Med High

_____ Student Health Care Payment Plan _____ Extra Dental

Athletic Commitments and ResponsibilitiesI have read and understand the following sections of the Athletic Packet:

• Academic Eligibility Standards• Athletic/Activity Code of Conduct• District Letter Regarding Insurance Coverage• Code of Ethics - Athletes• Emergency Card

• Physical Form• Student Insurance• Participation Donation Letter• Medical Treatment Authorization-Waiver, Release,

and Indemnity Agreement

___________________________________ ______________________________ ________________Signature of Parent/Guardian Signature of Student Date

Ath/Act Rpt 6/04, 4/05, 7/06, 7/10

Sport/Activity1._______________2._______________3.______________

Why am I getting this Information sheet? You are receiving this information sheet about concussions because of California state law AB 25 (effective January 1, 2012), now Education Code § 49475.

1. The law requires a student athlete who may have a concussion during a practice or game to beremoved from the activity for the remainder of the day.

2. Any athlete removed for this reason must receive a written notice from a medical doctor trained in themanagement of concussion before returning to practice.

3. Before an athlete can start the season and begin practice in a sport, a concussion information sheetmust be signed and returned to school by the athlete and the parent or guardian.

Every 2 years all coaches are required to receive training about concussions (AB 1451), as well as certification in First Aid training, CPR, and AEDs (life-saving electrical devices that can be used during CPR).

What is a concussion and how would I recognize one? A concussion is a kind of brain injury. It can be caused by a bump or hit to the head, or by a blow to another part of the body with the force that shakes the head. Concussions can appear in any sport, and can look differently in each person.

Most concussions get better with rest and over 90% of athletes fully recover, but, all concussions are serious and may result in serious problems including brain damage and even death, if not recognized and managed the right way.

Most concussions occur without being knocked out. Signs and symptoms of concussion (see back of this page) may show up right after the injury or can take hours to appear. If your child reports any symptoms of concussion or if you notice some symptoms and signs, seek medical evaluation from your team's athletic trainer and a medical doctor trained in the evaluation and management of concussion. If your child is vomiting, has a severe headache, is having difficulty staying awake or answering simple questions, he or she should be immediately taken to the emergency department of your local hospital.

On the CIF website is a Graded Concussion Symptom Checklist. If your child fills this out after having had a concussion, it helps the doctor, athletic trainer or coach understand how he or she is feeling and hopefully shows progress. We ask that you have your child fill out the checklist at the start of the season even before a concussion has occurred so that we can understand if some symptoms such as headache might be a part of his or her everyday life. We call this a "baseline" so that we know what symptoms are normal and common. Keep a copy for your records and turn in the original. If a concussion occurs, he or she should fill out this checklist dally. This Graded Symptom Checklist provides a list of symptoms to compare over time to make sure the athlete is recovering from the concussion.

What can happen if my child keeps playing with concussion symptoms or returns too soon after getting a concussion? Athletes with the signs and symptoms of concussion should be removed from play immediately. There Is NO same day return to play for a youth with a suspected concussion. Youth athletes may take more time to recover from concussion and are more prone to long-term serious problems from a concussion.

Even though a traditional brain scan (e.g., MRI or CT) may be "normal", the brain has still been injured. Animal and human studies show that a second blow before the brain has recovered can result in serious damage to the brain. If your athlete suffers another concussion before completely recovering from the first one, this can lead to prolonged recovery (weeks to months), or even to severe brain swelling (Second Impact Syndrome) with devastating consequences.

There is an increasing concern that head impact exposure and recurrent concussions contribute to long-term neurological problems. One goal of this concussion program is to prevent a too-early return to play so that serious brain damage can be prevented.

Signs observed by teammates, parents, and coaches include:

Symptoms may include one or more of the following:

• Looks dizzy• Looks spaced out• Confused about plays• Forgets plays• Is unsure of game, score, or opponent• Moves clumsily or awkwardly• Answers questions slowly• Slurred speech• Shows a change in personality or way of acting• Can't recall events before or after the Injury• Seizures or has a fit• Any change in typical behavior or personality• Passes out

• Headaches• "Pressure In head"• Nausea or throws up• Neck pain• Has trouble standing or walking• Blurred, double, or fuzzy vision• Bothered by light or noise• Feeling sluggish or slowed down• Feeling foggy or groggy• Drowsiness• Change In sleep patterns• Loss of memory• “Don’t feel right”• Tired or low energy• Sadness• Nervousness or feeling on edge• Irritability• More emotional• Confused• Concentration or memory problems• Repeating the same question/comment

What Is Return to Learn? Following a concussion, student athletes may have difficulties with short- and long-term memory, concentration and organization. They will require rest while recovering from injury (e.g., avoid reading, texting, video games, loud movies), and may even need to stay home from school for a few days. As they return to school, the schedule might need to start with a few classes or a half-day depending on how they feel. They may also benefit from a formal school assessment for limited attendance or homework such as reduced class schedule, if recovery from a concussion is taking longer than expected. Your school or doctor can help suggest and make these changes. Student athletes should complete the Return to Learn guidelines and return to complete school before beginning any sports or physical activities. Go to the CIF website (dfstate.org) for more information on Return to Learn.

How Is Return to Play (RTP) determined? Concussion symptoms should be completely gone before returning to competition. A RTP progression involves a gradual, step-wise increase ln physical effort, sports-specific activities and the risk for contact. If symptoms occur with activity, the progression should be stopped. If there are no symptoms the next day, exercise can be restarted at the previous stage.

RTP after concussion should occur only with medical clearance from a medical doctor trained in the evaluation and management of concussions, and a step-wise progression program monitored by an athletic trainer, coach, or other identified school administrator. Please see cifstate.org for a graduated return to play plan. [AB 2127, a California state law that became effective1/1/15, states that return to play (I.e., full competition) must be no sooner than 7 days after the concussion diagnosis has been made by a physician.]

Final Thoughts for Parents and Guardians: It is well known that high school athletes will often not talk about signs of concussions, which is why this information sheet is so important to review with them. Teach your child to tell the coaching staff if he or she experiences such symptoms, or if he or she suspects that a teammate has suffered a concussion. You should also feel comfortable talking to the coaches or athletic trainer about possible concussion signs and symptoms.

References: • American Medical Society for Sports Medicine position statement: concussion in sport (2013)• Consensus statement on concussion in sport: the 4th International Conference on Concussion In Sport held In Zurich, November 2012• http;//www.cdc.gov/concussion/HeadsUp/youth.html

Please Return this Page

I hereby acknowledge that I have received the Concussion Information Sheet from my school and I have read and understand its contents. I also acknowledge that if I have any questions regarding these signs, symptoms and the “Return to Learn” and “Return to Play” protocols, I will consult with my physician.

_________________________ ________________________ _____________________ Student-athlete Name Printed Student-athlete Signature Date

_________________________ ________________________ _____________________ Parent/Guardian Name Printed Parent/Guardian Signature Date

CA STATE LAW AB 2127 (Effective 1/1/15) STATES THAT RETURN TO PLAY (I.E., COMPETITION) CANNOT BE SOONER THAN 7 DAYS AFTER EVALUATION BY A PHYSICIAN (MD/DO) WHO HAS MADE THE DIAGNOSIS OF CONCUSSION.

Instructions: • This graduated return to play protocol MUST be completed before you can return to FULL COMPETITION.

o A certified athletic trainer (AT), physician, or identified concussion monitor (e.g., coach, athletic director),must Initial each stage after you successfully pass it.

o Stages I to II-D take a minimum of 6 days to complete.o You must be back to normal academic activities before beginning Stage II.o You must complete one full practice without restrictions (Stage Ill) before competing in first game.

• After Stage I, you cannot progress more than one stage per day (or longer if instructed by your physician).• If symptoms return at any stage in the progression, IMMEDIATELY STOP any physical activity and

follow up with your school’s AT, other identified concussion monitor, or your physician. In general, ifyou are symptom-free the next day, return to the previous stage where symptoms had not occurred.

• Seek further medical attention if you cannot pass a stage after 3 attempts due to concussionsymptoms, or if you feel uncomfortable at any time during the progression.

You must written physician (MD/OD) clearance to begin and progress through the following stages as outlined below (or as otherwise directed by physician)

Date & Initials

Stage Activity Exercise Sample Objective of the Stage

I No physical activity for at least 2 full symptom-free days AFTER you have seen a physician

No activities requiring exertion (weightlifting, jogging, P.E. classes)

Recovery and elimination of symptoms

II-A Light aerobic activity • 10-15 minutes of walking or stationary biking

• Must be performed under direct supervision by designated individual

• Increase heart rate to no more than 50%of perceived max. exertion (e.g., < 100 beats per minute)

• Monitor for symptom return II-B Moderate aerobic activity

Light resistance training

• 20-30 minutes jogging or stationary biking • Body weight exercises (squats, planks,

push-ups), max 1 set of 10, no more than 10 min total

• Increase heart rate to 50-75% max. exertion (e.g., 100-150 bpm)

• Monitor for symptom return

II-C Strenuous aerobic activity Moderate resistance training

• 30-45 minutes running or stationary biking • Weightlifting < 50% of max weight

• Increase heart rate to > 75% max. exertion

• Monitor for symptom return II-D Non-contact training with sport-specific drills

No restrictions for weightlifting • Non-contact drills, sport-specific activities

(cutting, jumping, sprinting) • No contact with people, padding or the

floor/mat

• Add total body movement • Monitor for symptom return

Minimum of 5 days to pass Stages I and II. Prior to beginning Stage III, please make sure that written physician (MD/OD) Clearance for return to play, after successful completion of Stages I and II, has been given to your school’s concussion monitor.

III Limited contact practice

Full contact practice

• Controlled contact drills allowed (no scrimmaging)

• Return to normal training (with contact)

• Increase acceleration, deceleration and rotational forces

• Restore confidence, assess readiness for return to play

• Monitor for symptom return MANDATORY: You must complete ONE contact practice before return to competition

(Highly recommended that Stage III be divided into 2 contact practice days as outlined above.) IV Return to play (competition) Normal game play Return to full sports activity without

restrictions

Athlete’s Name:_________________________________________Date of Concussion Diagnosis:______________________

A Sudden Cardiac Arrest Information Sheet for Athletes and Parents/Guardians

What is sudden cardiac arrest? Sudden cardiac arrest (SCA) is when the heart stops beating, suddenly and unexpectedly.When this happens blood stops flowing to the brain and other vital organs. SCA is NOT aheart attack. A heart attack is caused by a blockage that stops the flow of blood to theheart. SCA is a malfunction in the heart’s electrical system, causing the victim to collapse.The malfunction is caused by a congenital or genetic defect in the heart’s structure.How common is sudden cardiac arrest in the United States? As the leading cause of death in the U.S., there are more than 300,000 cardiac arrestsoutside hospitals each year, with nine out of 10 resulting in death. Thousands ofsudden cardiac arrests occur among youth, as it is the #2 cause of death under 25and the #1 killer of student athletes during exercise.

Who is at risk for sudden cardiac arrest?SCA is more likely to occur during exercise or physicalactivity, so student-athletes are at greater risk. Whilea heart condition may have no warning signs, studiesshow that many young people do have symptoms butneglect to tell an adult. This may be because they areembarrassed, they do not want to jeopardize their play-ing time, they mistakenly think they’re out of shape and need to train harder, orthey simply ignore the symptoms, assuming they will “just go away.” Additionally,some health history factors increase the risk of SCA.

What should you do if your student-athlete is experiencing any of thesesymptoms? We need to let student-athletes know that if they experience any SCA-relatedsymptoms it is crucial to alert an adult and get follow-up care as soon as possiblewith a primary care physician. If the athlete has any of the SCA risk factors, theseshould also be discussed with a doctor to determine if further testing is needed.Wait for your doctor’s feedback before returning to play, and alert your coach,trainer and school nurse about any diagnosed conditions.

The Cardiac Chain of SurvivalOn average it takes EMS teams up to 12 minutes to arrive

to a cardiac emergency. Every minute delay in attending

to a sudden cardiac arrest victim decreases the chance

of survival by 10%. Everyone should be prepared to take

action in the first minutes of collapse.

Early Recognition of Sudden Cardiac ArrestCollapsed and unresponsive.Gasping, gurgling, snorting, moaning or labored breathing noises.Seizure-like activity.

Early Access to 9-1-1Confirm unresponsiveness.Call 9-1-1 and follow emergency dispatcher's instructions.Call any on-site Emergency Responders.

Early CPRBegin cardiopulmonary resuscitation(CPR) immediately. Hands-only CPR involves fastand continual two-inch chest compressions—about 100 per minute.

Early DefibrillationImmediately retrieve and use an automated external defibrillator (AED) as soon as possible to restore the heart to its normal rhythm. MobileAED units have step-by-step instructions for a by-stander to use in an emergency situation.

Early Advanced CareEmergency Medical Services (EMS) Responders begin advanced life support including additional resuscitative measures andtransfer to a hospital.

Cardiac Chain of Survival Courtesy of Parent Heart Watch

What is an AED? An automated external defibrillator (AED) is the only way to save a suddencardiac arrest victim. An AED is a portable, user-friendly device that automat-

ically diagnoses potentially life-threatening heartrhythms and delivers an electric shock to restore nor-mal rhythm. Anyone can operate an AED, regardless oftraining. Simple audio direction instructs the rescuerwhen to press a button to deliver the shock, whileother AEDs provide an automatic shock if a fatal heartrhythm is detected. A rescuer cannot accidently hurt a

victim with an AED—quick action can only help. AEDs are designed to onlyshock victims whose hearts need to be restored to a healthy rhythm. Checkwith your school for locations of on-campus AEDs.

A E D

FAINTINGis the

#1SYMPTOMOF A HEART CONDITION

Keep Their Heart in the Game

Recognize the Warning Signs & Risk Factorsof Sudden Cardiac Arrest (SCA)

Tell Your Coach and Consult Your Doctor if These Conditions are Present in Your Student-Athlete

What is CIF doing to help protect student-athletes?CIF amended its bylaws to include language that adds SCA training to coach certification and practice and game protocol that empowers coaches toremove from play a student-athlete who exhibits fainting—the number one warning sign of a potential heart condition. A student-athlete who has beenremoved from play after displaying signs or symptoms associated with SCA may not return to play until he or she is evaluated and cleared by a licensedhealth care provider. Parents, guardians and caregivers are urged to dialogue with student-athletes about their heart health and everyone associatedwith high school sports should be familiar with the cardiac chain of survival so they are prepared in the event of a cardiac emergency.

I have reviewed and understand the symptoms and warning signs of SCA and the new CIF protocol to incorporate SCA prevention strategies into my stu-dent’s sports program.

STUDENT-ATHLETE SIGNATURE PRINT STUDENT-ATHLETE’S NAME DATE

PARENT/GUARDIAN SIGNATURE PRINT PARENT/GUARDIAN’S NAME DATE

For more information about Sudden Cardiac Arrest visit

California Interscholastic Federation Eric Paredes Save A Life Foundation National Federation of High Schoolshttp.www.cifstate.org http:www.epsavealife.org (20-minute training video)

https://nfhslearn.com/courses/61032

Potential Indicators That SCA May Occur� Fainting or seizure, especially during or

right after exercise

� Fainting repeatedly or with excitement orstartle

� Excessive shortness of breath during exercise

� Racing or fluttering heart palpitations or irregular heartbeat

� Repeated dizziness or lightheadedness

� Chest pain or discomfort with exercise

� Excessive, unexpected fatigue during orafter exercise

Factors That Increase the Risk of SCA� Family history of known heart abnormalities or

sudden death before age 50

� Specific family history of Long QT Syndrome, Brugada Syndrome, Hypertrophic Cardiomyopathy, orArrhythmogenic Right Ventricular Dysplasia (ARVD)

� Family members with unexplained fainting, seizures,drowning or near drowning or car accidents

� Known structural heart abnormality, repaired or unrepaired

� Use of drugs, such as cocaine, inhalants, “recreational” drugs, excessive energy drinks or performance-enhancing supplements

Keep Their Heart in the Game

PALOS VERDES PENINSULA HIGH SCHOOL

ATHLETIC AND CO-CURRICULAR CODE OF CONDUCT

Students and parents shall be informed that a student who competes in athletics or extra and co-curricular activities is held to specific standards of conduct and citizenship. These standards apply throughout the school year. When students and parents sign and return the Code of Conduct, they are indicating that they understand the Code and the consequences that will follow if it is violated.

VIOLATIONS OF THE CODE A. Violations involving drugs, alcohol, and/or drug paraphernalia will result in a school suspension and six-week co-

curricular suspension from athletics and all other school activities. The student will also be required to attend six class sessions in “The Outlook Program,” which is an educational approach to substance abuse.

B. Any Category 1 or 2 violation of the “The Safe School Policy” may require removal of the student from Peninsula High School and/or referral to law enforcement.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

10932 Pine Street Telephone: 562-493-9500 Los Alamitos, California 90720 Fax: 562-493-6266

Code of Ethics - Athletes Athletics is an integral part of the school’s total educational program. All school activities, curricular and extra-curricular, in the classroom and on the playing field, must be congruent with the school’s stated goals and objectives established for the intellectual, physical, social and moral development of its students. It is within this context that the following Code of Ethics is presented.

As a condition of membership in the CIF, all schools shall adopt policies prohibiting the use and abuse of androgenic/anabolic steroids. All member schools shall have participating students and their parents, legal guardian/caregiver agree that the athlete will not use steroids without the written prescription of a fully licensed physician (as recognized by the AMA) to treat a medical condition (Article 523).

By signing below, both the participating student athlete and the parents, legal guardian/caregiver hereby agree that the student shall not use androgenic/anabolic steroids without the written prescription of a fully licensed physician (as recognized by the AMA) to treat a medical condition. We recognize that under CIF Bylaw 202, there could be penalties for false or fraudulent information.

We also understand that the _____PV Peninsula High School - PVPUSD_____ (school/school district name) policy regarding the use of illegal drugs will be enforced for any violations of these rules.

A copy of this form must be kept on file in the athletic director’s office at the local high school on an annual basis and the Principal’s Statement of Compliance must be on file at the CIF Southern Section office. (Revised 7/08) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - As a participant in athletics or extra-curricular activities, I understand that it is my responsibility to:

1. Place academic achievement as the highest priority.2. Show respect for fellow students, teachers, school staff, teammates, opponents, officials and coaches.3. Respect the integrity and judgment of teachers, school staff, and game officials.4. Exhibit fair play, sportsmanship and proper conduct on and off the playing field, including extra-curricular

activities.5. Maintain a high level of safety awareness.6. Refrain from the use of profanity, vulgarity and other offensive language and gestures.7. Adhere to the established rules and standards of the game to be played and of extra-curricular activities.8. Respect all equipment and use it safely and appropriately.9. Refrain from the use and/or possession of alcohol, tobacco, prescription drugs, non-prescriptive drugs,

anabolic steroids or any substance to increase physical development or performance that is not approved bythe United States Food and Drug Administration, Surgeon General of the United States or American MedicalAssociation.

10. Know and follow all state, section and school athletic and academic rules and regulations as they pertain toeligibility and sports or extra-curricular participation.

11. Win with character, lose with dignity.

DATED:_________________________

____________________________________ ____________________________________ Parent / Caregiver Signature Student / Athlete Signature

____________________________________ (rev 10/12/11) Student / Athlete Printed Name

PALOS VERDES PENINSULA UNIFIED SCHOOL DISTRICT MEDICAL TREATMENT AUTHORIZATION

WAIVER, RELEASE AND INDEMNITY AGREEMENT ASSUMPTION OF RISK FOR PARTICIPATION IN A VOLUNTARY SPORTS OR NON-SPORTS PROGRAM

Participant:______________________________________________________________________________

Description of Activity: _____________________________ Name of School:_________________________

Date(s) of Activity:__________________________________________________________________

Transportation provided by District Transportation is parent responsibility

By my signature below, I hereby give permission for my son/daughter to participate in the above-described activity. I realize that this activity is voluntary as part of the PALOS VERDES PENINSULA UNIFIED SCHOOL DISTRICT (District) sports or non-sports program. I understand that this activity could cause serious illness and/or injury or death, and I assume all risks for any such illness and/or injury or death. I am aware of the transportation arrangements for this activity and acknowledge that if the school is providing no transportation, the parent has complete and sole responsibility for all transportation arrangements. I am aware that the District does not provide coverage for medical treatment in connection with this activity. If a participant does not have private medical insurance, low-cost school insurance is available through the District.

For and in consideration of permitting the above named child to participate in the activity described above, the undersigned hereby voluntarily releases, discharges, waives and relinquishes any and all actions or causes of action for personal injury, bodily injury, property damage or wrongful death occurring to his/her child/ward or him/herself arising in any way whatsoever as a result of engaging in said activity or any activities incidental thereto wherever or however the same may occur and for whatever period said activities may continue. The undersigned does for him/herself, his/her heirs, executors, administrators and assigns hereby release, waive discharge and relinquish any action or causes of action, aforesaid, which may hereafter arise for him/herself and for his/her estate, and agrees that under no circumstances will he/she or his/her heirs, executors, administrators and assigns prosecute, present any claim for personal injury, bodily injury, property damage or wrongful death against the District or any of its officers, agents, or employees for any of said causes of action, whether the same shall arise by the negligence of any of said persons, or otherwise.

The undersigned hereby acknowledges that he/she knowingly and voluntarily assumes all risks of bodily injury to his/her child/ward or him/herself, as stated, and expressly acknowledges their intention, by executing this instrument, to exempt and relieve the District, its officers, agents, and employees, from any liability for personal injury, bodily injury, property damage or wrongful death that may arise out of or in any way be connected with the above-described activity. I have read and understand the foregoing and have voluntarily signed this agreement. I am aware of the potential risks involved in this activity and I am fully aware of the legal consequences of signing this instrument. I further acknowledge that the District does not automatically provide for medical coverage for participants in this activity.

Health or special needs: Check as appropriate.

Participant has no special health needs the staff should be aware of, and no medication is required. Participant has a special need, and instructions are attached. Number of attached pages:________.Other:

In the event of illness or injury, I do hereby consent to whatever x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care and emergency transportation considered necessary in the best judgment of the attending physician, surgeon, or dentist and performed under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services.

__________________________________________ ___________________________ ___________________ Parent/Guardian Signature Participant Signature Date

__________________________________________ __________________________ ___________________ Parent/Guardian Name (Please Print) Phone Number Health Plan

_______________________________________________________ Plan # ___________________________Street Address City State Zip Code

F-603 – Voluntary Sports/Non-Sports Waiver (Rev 7-20-12) Principal / Designee Signature

PV Peninsula HS2017-2018 School Year

X

Palos Verdes Peninsula High SchoolHazing Pledge

"Hazing" means any method of initiation or pre-initiation into a student organization or student body, whether or not the organization or body is officially recognized by an

educational institution, which is likely to cause serious bodily injury to any former, current, or prospective student of any school, community college, college, university, or other

educational institution in this state. The term “hazing" does not include customary athletic events or school-sanctioned events.

‘Hazing’ is strictly prohibited by the Palos Verdes Peninsula Unified School District and is grounds for suspension and/or expulsion (AR 5144.1).

All students and parents must read and sign this card and return to their coach/teacher; thus acknowledging the pledge against ‘hazing’ acts.

If a student/parent does not sign the ‘hazing pledge’ the student will not be permitted to participate in the activity/sport.

Student Parent Signature

Print Student Name / Grade: Print Sport / Activity: