Panther Dance Team
2010 - 2011 Application
***Please attach a recent non-returnable photograph along with application***
Address: ____________________________________________________________ Email Address:__________________________
City: ________________________________††State: _______†Zip: ____________†††† Cell Phone: ____________________________
Please provide emergency contact and your health insurance information. Although insurance is not required to tryout, each candidate is responsible for his or her own medical expenses in case an accident should happen. (see release statement below)
Contact Name: ________________________________† Phone: _____________________
Insurance Company: ________________________________________________________
Personal Information (To be used for squad member press releases and team promotions)
Name (as you want listed in pictures and press releases):______________________________________________ †
Hometown: _________________________________† Name of local newspaper: ____________________________
High School: ________________________________† Major (or academic interest): _________________________
Dance Studio Attended: _____________________________________ Years at studio: ______________________
Years on High School Dance Team (specify whether on Varsity or JV): ___________________________________
Describe Dance Background and Accomplishments:_____________________________________________________________________________________†
Why are you interested in becoming a member of the Panther Dance Team? ___________________________________________________
How did you hear about tryouts? ______________________________________________________________________________________________________
Release Statement/Hold Harmless Agreement
I understand that my participation in the Panther Dance Team Clinics and tryouts, at the University of Wisconsin-Milwaukee is purely voluntary. I also agree that I will be available for the entire term of the position, April 2010 - April 2011, and will not graduate before May 2011.
As in any athletic or physical activity, I understand there is risk for injury and bodily harm (including accidental death). I agree to hold harmless and indemnify the Panther Dance Team members, coach, advisor, and any tryout staff against all loss, liability, damage or expense (including costs and attorney fees) by reason of liability imposed upon it by law for damages because of such participation. I also acknowledge that I am in excellent physical and mental condition that will allow for participation in an aerobic exercise situation. The undersigned is encouraged to secure adequate insurance protection, as the Panther Dance Team does not provide medical insurance coverage covering such injury.
The State of Wisconsin grants collegiate student organization the right to organize with out administrative interference; therefore, the University of Wisconsin-Milwaukee is not liable for actions or debts created by student organizations. Although this activity may occur on the campus of the University of Wisconsin-Milwaukee, the Panther Dance Team is not eligible for liability protection under the State of Wisconsin Self-Funded Liability Program. The undersigned understands that this activity is amateur and informal, and not part of the University of Wisconsin-Milwaukee University.
Your signature acknowledges that you have read and understand the Dance Team Memberís Responsibilities (available on the Dance Teamís web site, http://www.danceteam.uwm.edu). A parentís signature acknowledges that he or she has read the application material and understand all of the responsibilities listed. Note: If you are under the age of 18, a parent or guardian must also sign.
Your Signature: ________________________________________________________ Date: __________
Parentís Signature (If Needed): ____________________________________________ Date: __________
|Panther Dance Team|
|Union Box 101, PO Box 413|
|Milwaukee, WI 53201-0413|