Document 6524924

2013 CHEER PARTICIPANT INFORMATION COVER SHEET
League Official Use Only
Fee Information
Amount Paid: - - -- Buy-Out Paid: _ _ _ __
How paid: _ _ _ _ __
Receipt #: _ _ _ _ __
Notes: - - - - - - - -
League Official Use Only
BC Birthdate:
League Age (as of713 II I3):_ __
Competition - YES NO
Comp. Div.: _ __ _ __
Comp Fees Paid: _ _ __
Comp Receipt#: _ _ __
ARENTS/LEGAL GUARDIANS FILL OUT THIS PORTION:
articipant Legal Name: -~~----------------o=~::r-------------:-:-=:-::--AS
IRS
MIDDLB
articipant Address:
ADDRESS
Siblings participating in this organization:
CIT
iZIP
Sibling Name: _ __ _ _ _ _ _ _ _ _ _ _ _ Age: _ _ _ __
Sibling Name: _ _ _ _ __ _ _ _ __ _ _ _ Age: _ __ __
other/Guardian Name: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Mother Address:
(if different from Participant's) ----::--::--::-c::-:-:---------------=c:=:-3--------=-=--
ADDRESS
CIT
iZIP
Cell hone: - - - - - - - - - - - - - - Home Phone: - - - - - - - - - - - -mail address (must be written clearly!): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
!Father Address:
(if different from Participant's)
------,-=-=-=~=-------------=-:-----------,-=-=--ADDRESS
CITY
iZ IP
Cell phone : _ _ _ _ _ _ _ _ _ _ _ _ ___
-mail address (please write clearly!): _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
LEAGUE OFFICIALS COMPLETE THIS SECTION:
Utility bill checked to verify address (Reg)
_ _ League received 2013 Cheer Contract (Reg)
League received 20 13 Parent Participation form (Reg)
League received Medical Authorization form and parent understands that the JAAFSCC group insurance is a
Secondary Excess Coverage over insurance provided by the parents' insurance coverage (Reg)
Medical Examination Form (AD)
League received signed 2013 Competition Contract/Waiver (Reg)
SOUTHERN CALIFORNIA JUNIOR ALL AMERICAN CONFERENCE, INC.
2013 PLAYER'S SEASON CONTRACT
(Please only com Jete the yellow highlighted section of this form)
(PLEASE REA D CAREFULLY)
Rev. 03/ 13
SECTION I (Chapter Officials will complete SECTION I after candidate has been assigned a specific Team, League and Division)
SCJ AA FC C ha pter ---'0=-=RA=N:..::....=G::..::E=C=-=-R=E=S=-=-T--'~=AA=-=-=F
,____ __
DIVISION: []JR. MICRO []MIC RO
SECTION II
OJR. P EE WEE
Tea m Na me ______________________________
[]J>EE WEE D M IDGET D c HEERLEA DI NG D
ETURNING D NEW
(TO BE COMPLETED BY CANDIDATE PLAYER PARENTI GUARDIA .V)
NO CANDIDATE will be permitted to participate in any activity until SECTIONS II , III, V and VI of this Contract has been completed in full.
The CAN DIDATE PLAYER agrees that he will faithfully abide by the Rules of the SCJAAFC to the very best of his ability.
Age(asof7 -3 1-1 3)
orne phone number (with area code)
Cell number Parent/Guardian
(with area code)
Cell number #2 (wi th area code)
SchooiName&Grade (asof7-31-13
Parent/Guardian e-mail addresses
SECTION Ill (TO BE COMPLETED BY CANDIDATE PLAYER PARENT/GUARDIAN)
EQ UIPMENT R ESPONS IBILITY
1/We as parent/guardian of said candidate do hereby assume full and complete for the proper care and maintenance of all equipment loaned by
Local Chapter to said candidate. I understand all equipment is to be used for SCJAAFC activities only and that all equipment remains the legal
property of Local Chapter. I agree to reimburse Local Chapter for any and all equipment that is lost, damaged or stolen for the full replacement
cost of said equipment, with payment due when equipment is requested by Local Chapter, or immediately upon the withdrawal of said candidate
from Local Chapter.
RULES AND REGULATION
1/We as parent/guardian of said candidate understand it is the responsibi lity of the parent/guardian, candidate, team and chapter to
comply with any and all rules and regulations ofSCJAAFC. Any noncomp liance with rules and regulation s shall be cause for
disciplinary action to be taken against said candidate, parent/guardian, team or chapter by SCJAAFC.
ARENT/GUARDIAN : Signature - - - - - - - - - - - - - - - - - - - - - --=;==.l rint Name -------------------=;;;;;;;;;" ate ---------------:--
ELATIONSHIP TO MINOR:
SECTION IV
FATHER 0
MOTHER 0
LEGAL GUARDIAN.- =
0 __ _ _ _ _ _ _____,
P ROOF O F AGE (TO BE COM PLE TED B Y TH E CHA PTER A THL E TIC DIRECTOR)
FULL Legal Nan1e: - - - - - - - - - - - - - - - - - - - - - - = : - - - - - : - - : - - - - - - - - - - - Birth date - - - - - - - - - - - - - - (No Nicknames) (Please print!)
(Month, Day, Year)
Proof of Age:
0 Birth Cert
Abstract
:::; Gov ' t ID
0 Record of foreign birth
0 School Record
0 Red Roster
MEDICAL EXAM INATION (TO BE COMPLETED BY A QUALIFIED DOCTOR OF MEDICINE)
SECTIO N V
Height
Weight
Blood Pr. _ __
0 Heart Ears 0 Nose OTeeth 0 Abdomen 0 Extremities 0 Hernia (recommended)
REMARKS : _ _ ~~~~-~~~--~--~~~~~~~~-~~-~-~-~~~-~.
( ) While this examination does not constitute a complete Medical Examination, it does on thi s date, and based upon my observation, meet the
requirement for participation in thi s youth football program .
( ) Individual examined by me thi s date is considered not phys ically qualified to participate in this youth football program for the fo llowing
Reasons:
Examining Dr. - -- - - - - - - - - - - - - - - - - - - - - Office Phone ____________________ Date _ _ _ _ _ __
SECTIO N IV
(TO BE COMPLETED BY RESPONSIBLE CHAPTER AND TEAM OFFICIALS ONLY)
In approving the above Candidate's Player Season Contract, we hereby certify that the Birth Certifi cate submitted does correspond with the name and birth date shown in
Sections I 1 and Ill. In addition, we hereby certi fy that the Parental Consent and Medical Treatment Authorizations, Section Ill, was completed, and, together with the Medical
Examination, Section IV, was completed by the qualifi ed Doctor of Medicine li sted, prior to the Candidate's participation in any manner with this team. We certify that we have
explained fully the procedures to fo ll ow in the event of injury, and that in- jury/insurance reporting must be performed in accordance with SCJAAFC rules and procedures.
Finally, we certi fy that a copy of the Player Season Contract was furn ished to the Parent(s) or Guardian, as applicable.
Responsible Chapter Official
Date Signed
Certification Official
Date Signed
ABOUT THE CONFERENCE/LEAGUE INSURANCE COVERAGE
SECTION VI . (TO BE COMPLETED BY CANDIDATE PLAYER PARENT/GUARDIAN)
PARENTAL CONSENT
l/We the parents/guardians of the minor named in Section II Candidate for a position on a SCJAAFC Team, hereby give my/our approval to his/her participation in any and all
SCJAAFC activities during the current season . l/We assume all risks and hazards incidental to such participation, including transportation to and from such activities. IIWe do
hereby waive, release, absolve, indemnify, and agree to hold harmless the team, the Chapter, and the SCJAAFC including sponsors and other related participants, for any injury
to my/our child. SCJAAFC has advertising, modeling and photo copyrights.
MEDICAL TREATMENT AUTHORIZATION
The SCJAAFC has Secondary Excess Accident-Medical Group Insurance coverage, with a deductible amount for each injury incurred. The SCJAAFC group insurance is
"SECONDARY EXCESS COVERAGE," over any valid collectable coverage provided by the parent's separate personal or employee's dependent group insurance. The
SCJAAFC secondary group covers one year from date of first treatment, for each injury, with dental coverage, for sound natural teeth, including dental X-rays. Abdominal
hernia and pre-existing conditions are excluded. In executing the foregoing release, llwe, the undersigned acknowledge and represent that llwe understand that any claim for
injuries which arises out of our child's participation, must be reported to the Team or Chapter Officials "IMMEDlA TELY" . The insurance claim form must be filled out and
delivered to the Conference Insurance Commissioner " WITHIN 30 DAYS" from the date of injury. l/We have read the foregoing release, understand it and signed it
voluntarily.
ff HE NAME OF OliR OWN AND/OR EMPLOYMENT GROUP INSURANCE COMPANY IS:
In the event of injury to MY/OUR Child, l/We hereby grant authority to a qualified Doctor of Medicine to render such medical treatment as sai d Doctor of Medicine deems
necessary under the circumstances.
LEASE LIST ALL ALLERGIES or mark NKA - - - - - - - - - - - - - - - - - - - - - - - -
A. IMPORT ANT NOTICE (State required "Disclosure" statement; C. I. C. Section 10270.2)
THIS IS AN EXCESS PLAN - The Medical Expense Benefit of this Plan (Program) is an ·'EXCESS" type benefit that picks up where
other coverage leaves off. If you have any other individual, rranchise, blanket or group (except automobile medical payments insurance)
coverage which provides benefits of services for, or by reason of, medical or dental care or treatment, then this Plan (Program) will pay
ONLY the medical expenses not provided or reimbursable under your other coverage. The premium for this Plan (Program) has been
reduced, taking this into account.
If you have any other coverage, you should first submit you claim under that coverage. You should submit a claim under this Plan
(Program) only if you have no other coverage or if your other coverage does not fully provide or pay for your medical care or treatment.
Failure to submit the claim to your primary carrier can result in delaying payment by SCJAAFC insurance carrier.
B. The Conference/League insurance is ·'EXCESS" only. This means that the Parents/Guardians OWN INS URANCE MUST BE
NOTIFIED OF THE I JURY . If the Parents/Guardians have insurance WITH PRE-PAID MEDICAL PLANS, such as Kaiser or Ross
Loos, the injured person MUST BE TAKEN TO THE PRE-PAJD MEDICAL FACILITIES, for treatment.
C. If insured ' s Parent' s/Guardians HAVE 0 OTHER I" OR PRJMARY INSURANCE; the Conference/League group insurance may
be used. BUT THERE IS A $100.00 DEDUCTIBLE FOR EACH INJURY.
D. The Conference/League group insurance PAYS ONLY TO THE HOSPITALS A D DOCTORS unless receipts are su bmitted
showing proof of payment by Parent/Guardian to the Hospital/Medical Treatment center. The following forms are required to process
the claim. I. Insurance Claim Form. 2. Chapter AD report of injury. 3. Copy of Parent/Guardian Insurance card. 4. Hippa Form (on
www.leaguelineup.com/jaafsc). 5. Copy of any medical bills. 6. Copy of player' s contract.
E. Any and all claims MUST be reported to your Chapter AD. The Chapter AD will then notify SCJAAF.
arent/ Guardian 'sName (Please Print)
elationship to Minor
Signature
loate
Orangecrest JAAF and Cheer
19510 Van Buren Blvd F-3 #225 - Riverside CA 92508
www.orangecrestwolves.org
2013 OCJAAF CHEER CONTRACT FORM
Participant's Full Legal N a m e - - - - - - - - - - - - - - - - - - - - -
League Age (as of 7-31-13) _ __
Parent/ Guardian's Full Legal Names: - - - - - - - - - - - - - and
Relationships to Qarticipant: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Handbook, By-laws, OCJAAF Registration, and JAAFSC Contract: Parents are responsible to know and adhere to the documents
that govern this organization . The OCJAAF by-laws and handbooks are located on our league's website for your review.
Sportsmanship: Through word and action , parents/spectators are expected to be a positive presence in this organization before,
during, and after practices, games, and competitions.
Honor our Mission Statement: The goal of the Orangecrest Wolves J.A.A.F. Youth Football and Cheer Organization is to teach
young men and women the fundamentals of football and cheer in an atmosphere that challenges and supports team sportsmanship,
individual self-discipline, physical fitness , and positive competition . We seek to comply with the rules and guidelines set forth by the
Southern California J.A.A.F. conference and our own Chapter by-laws. We hope to create meaningful experiences for each participant
that they may take what they have learned and the relationships they have formed , to remain active in this and other youth programs. It
is our desire that the participants witness the value of adult volunteer service and that the Orangecrest J.A.A.F . Youth Football and
Cheer organization serves as a positive presence in the community.
Parent Participation : Our football and cheer teams are only as strong as our parent teams. An important component of our registration
process and league success is our parent participation . At least one parent/guardian per child must volunteer in some capacity.
Fundraiser: Each child is required to participate and fulfill the fundraiser obligation or buy-out for $75 via cash or debit/credit (Visa or
Mastercard only). The fundraiser/buyout is due on or before Friday, August 30, 2013. League pictures, trophies, yearbooks, and
competition patches will be dispersed only after all financial obligations have been met.
Sponsorship: Each football team is required to raise $600 to pay for team insurance. Cheer (as a whole) is required to raise $1200.
Fees: Registration fees must be paid in a timely manner. The cheer registration fee is $445 for NEW participants and $165 for
RETURNING participants, and can be made in installments until the last sign-up date and uniform fitting day of 6/29/13 - NO
EXCEPTIONS. Fees do not include optional items such as cheer bags, megaphone bags, warm-up suits, etc. There is a separate fee
of $75 for Competition that is due on or before 9/17/13 to be able to participate in Competition . Competition fees are nonrefundable.
All fees may be paid with a money order, cash , or with a Visa or Mastercard credit/debit card .
Refunds: Cheer registration refunds will be issued if requested in writing prior to the first day of practice. Refunds will not be given
for cheer uniforms and cheer accessories that have already been ordered as they cannot be returned . If a participant suffers a seasonending injury, before the first game in regular-season play, as verified in writing by a medical doctor, the parent may request a refund of
$50 ($70 reg istration fee , less spirit pack). There will be no other refunds for any reason after the first day of practice.
Uniforms: Each new cheerleader will receive a full cheer uniform that includes skirt, shell, sleeves, brief, poms, megaphone, hair bow,
shoes and socks. Returning cheerleaders will receive shoes, socks, poms and hair bow. Parents must provide practice clothes and
practice shoes.
Photography: There are often photos being taken of the kids. These photos may be posted on the website or in league albums.
_Initial here if you give your consent for your child to be photographed and her photo to be posted in connection with OCJAAF.
Parking and other rules: Adherence to parking and all other rules at all fields , including Orange Terrace Park and any visitors' field , is
mandatory and necessary for our continued ability to use these facilities .
We acknowledge that we are aware that the OCJAAF Cheer handbook, League handbook and by-laws are located on the
league's website and hereby agree to comply with all of the by-laws, rules and regulations of the Southern California Junior
All American Football Conference and the Orangecrest Youth Football and Cheer Program, both at home and away, and
understand that it is our responsibility to inform our guests of the rules and expectations.
Parent/Guardian Signature: - - - - - - - - - - - - - - - - - - - -
Dated : _ _ _ _ _ __
Parent/Guardian Signature: - - - - - - - - - - - - - - - - - - - -
Dated : _ _ _ _ _ __
Orangecrest JAAF and Cheer
19510 Van Buren Blvd F-3 #225- Riverside CA 92508
www.orangecrestwolves.org
2013 MANDATORY PARENT PARTICIPATION FORM
Dear Parent and Guardians,
Volunteers run this entire league and you are needed! Even if this is your first year with us, we will inaugurate you!
There are so many people to train, support and encourage you that anything you volunteer for will be fun and exciting!
With over 300 participants, there is much to be done. That's why Parent Participation is such an important component of
our league and a mandatory part of the registration.
lease rank your to three choices by marking 1-for most desired, 2-second most and 3-third.
_Head Coach*- submit coaching app
Banquet Committee
Cheer Snacks
_Assistant Coach *- submit coaching app
Competition Committee
Help at Sign-Ups
_Cheer Coach* submit coaching app
Snack Bar Worker
Banners
Team Athletic Director*
Spirit Wear Worker
Snack Donations
Uniforms
League Board Member
Team Parent *
_Dai ly Attendance Recorder
Photos for Cheer DVD
* Volunteer positions in which you are in direct contact with the participants. You will be run under Megan's Law. I agree that I
may also be required to complete a Livescan, fingerprinting background check.
Your FULL LEGAL Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Your Birthdate _ _ _ _ _ __
Child Participant's Name
Your Home address
Child's League Ag
Your hone (w/ area code)- - - - - - - - - - - - - - - -
mployer ___________ Occupation _____________ Phone (with area code
rovide a brief summary of your knowledge/ex erience of youth sports and more s ecifically, cheer:
Have you ever been convicted of a crime? YES/NO If yes, please explain and include when and in which state:
Ifyou are volunteering for a position in which you are in direct contact with any participants, please also complete the driver's
license information. By filling in this information, I give my permission for this organization to conduct a background check on
me, which may include sex offender, child abuse and criminal history backgrounds.
river's License # _________________________ State ___________ Expir'-'e""s.&.---------
Please read and sign to complete this form:
Parent participants must realize they hold a position of trust and responsibility in a youth program, which deals with a sensitive and
impressionable period in a child's development. All parent participants must have patience, understanding and good communication
skills with both children and adults. I acknowledge that I am aware that the OCJAAF by-laws and handbook are located on the
league 's website for review and l agree to comply with all of the by-laws, rules and regulations of the Southern California Junior All
American Conference and Orangecrest Wolves Youth Football and Cheer Program. l understand I can be removed from this
organization if the above is violated.
Signature_______________________________________
Date______________
J .A.A.F.S.C.
Medical Examination From
Season 2013
This form satisfies Section IV of Player's Season Contract. This form MUST be completed by a
qualified Doctor of Medicine, Doctor of Osteopathy, Nurse Practitioner or Physician's Assistant as
described in rules, Article III, Section C, and Certification #2.)
J.A.A.F.S.C. Chapter: ORANGECREST
First Name
Last Name
Middle
Team Name: CHEER
Birth Date
Age
City, State
Address
Phone
Zip code
Height
Weight
Blood Pressure
Q Heart
I:JEars
I:JNose
I:J Teeth
i:JAbdomen
I:J Extremities
Q Hernia (recommended)
Remarks: ___________________________________________________________________________
(
)
( )
While this examination does not constitute a complete Medical Examination,
it does on this date, and based upon my observations, meet the requirements for
participation in this youth football program.
Individual examined by me on this date is considered not physically qualified to participate in
this youth football program for the following reasons:
Explanation
Examining Dr. -------------------------------------- Office Phone ____________
Signature
Stamp required
Date:
Orangecrest JAAF and Cheer
19510 Van Buren Blvd F-3 #225 - Riverside CA 92508
www.oranqecrestwolves.orq
CHEER COMPETITION CONTRACT
I, the parent/guardian of
in signing this contract,
agree to the terms set forth herein for my child to participate in the SOAAF Cheer Competition
scheduled for Sunday, November 10, 2013 at the 66ers Stadium in San Bernardino, California.
•
•
I understand that competition requires 100°/o commitment/participation from both my
cheerleaders and myself and agree to make that commitment by my signature below.
I understand that my child will be part of a team that needs and depends on all members
being present to function as such. Excessive absences and/or tardiness could result
in being asked to step down from the team.
•
•
•
•
•
•
•
•
My child will attend all competition practices each week beginning the first week of
September and continuing through the competition date, including any additional practices
that may be deemed necessary by the Cheer Coordinators and Coaches.
I understand that these practices are scheduled to be held at Orange Terrace Park, but the
location is subject to change.
I understand that it is my responsibility to take my child to and from these competition
practices and not the responsibility of the league/coach.
My child will receive instruction on tumbling, choreography and stunting under the
superVision of trained coaches and possibly professional athletes for the purpose of
competing in November 2013 with Orangecrest Cheer.
I understand that there is a competition fee of $75 to pay for the cost of choreography,
tumbling coaches, facility use and fees associated with competition, and that this fee is
payable on or before Tuesday, September 17, 2013 and can be made in installments
from the date of sign-ups until the 8/10/13 due date via cash or credit/debit card.
I understand that additional unanticipated costs may arise and the Orangecrest Cheer will
hold fundraiser(s) to cover those costs. I therefore agree to fully participate and support all
fundraising and sponsorship efforts made by Cheer to cover remaining competition costs.
I understand that my child may not miss more than two (2) league football games during
the season to be eligible to compete in competition in accordance with the SOAAF
Conference Rule Book located on their website at www.scjaaf.com.
I understand that I must communicate all absences with the Coach and/or Coordinator
prior to the occurrence. I am aware of the Conference Rules on missing practices (no
more than two (2) excused absences in one week to be eligible to cheer at the game)
and I understand that if my child misses more than two practices during the week, she is
still required to attend the game in full uniform, check in with the squad, but will not be able
to cheer with the squad.
I hereby give my permission for my child to participate in the SOAAF Cheer Competition on
November 10, 2013 at the 66ers Stadium in San Bernardino, California, in accordance with the
Competition Contract as stated.
Parent/Guardian Name (please print)
WAIVER:
Parent/Guardian Signature
I choose to opt out of competition for my child.
INITIAL HERE
REGISTRATION AND COMPETITION FEE SCHEDULE
New Cheerleader Registration Package: $445*
INCLUDES: Shell w/ name
Skirt
Sleeves
Metallic porn poms
Hair bow
Socks (2 pair)
Shoes
Megaphone w/ graphics and name
Trophy
Yearbook
League Photo Package
Practice T-shirt
Water bottle for practice
Cheer clinic fee and lunch
Returner Cheerleader Registration Package: $165*
INCLUDES: Hair bow
Socks (2 pair)
Shoes
Trophy
Yearbook
League Photo Package
Practice T-shirt
Water bottle for practice
Cheer clinic fee and lunch
RETURNERS: Please let the coordinators know at sign-ups if your daughter will need
new uniform pieces so they can be fitted and ordered. There will be an additional fee
for each new item ordered.
*New and Returner fees are due 6/29/13 and can be paid in installments up
to the due date.
Competition Fee: $75 (due on or before 9/17/13)
INCLUDES: Competition Fee
SOAAF Competition T-Shirt
Lunch
Socks
Competition hair bow
Competition hair piece
Competition Day Water and Snacks