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Kehler’s All-Stars Cheer Program 2010 – 2011 Information Form

Name

Parent Cell :

Home Phone:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_____________________

____________________

A g e a s o f A u g u s t 3 1 , 2 0 1 0 _ _ _ _ _ _ _ _ _ _

Birthday______________________

Parent’s Email: (Print Clearly)

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Have you cheered before?

Yes

No

If so, where?

_____________________

Please list any cheer squad that you are currently a member.:

__________________________________________

What stunt position do you have experience in? NONE

FLYER

BASE

BACKSPOT

P l e a s e l i s t a n y p r e v i o u s d a n c e o r g y m n a s t i c s e x p e r i e n c e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Please check your most advanced level of Stunting Skill Level

Level 1 (No experience or level 1 stunt or preps)

Level 2 (Preps, Extensions, Straight Cradles and Basket Tosses)

Level 3 (Extended one-leg stunts, Extended Full twisting two-leg dismounts, single trick basket tosses) Level 4 (Extended one-leg stunts, Double twisting two-leg dismounts, kick-full basket tosses) Level 5 (Double twisting one-leg stunts, Double twisting basket tosses, Full up)

Please Check ALL Tumbling Skills you can PERFORM CONSISTANTLY on the FLOOR with NO SPOT

Standing Tumbling

Running Tumbling

___ ___ ___ ___ ___ ___ ___

Forward/Backward Roll Cartwheel/Round-off Back Walkover Back Handspring Two Back Handsprings Standing Tuck Backhandspring Tuck

___ ___ ___ ___ ___ ___

Cartwheel Round-off Back Handspring Backhandspring Tuck Full Front Handspring Aerial

___ ___ ___ ___ ___ ___

Round-off 2+ Back Handsprings Backhandspring Layout Back Tuck Front Tuck Arabian

What skills are you working on? (Still require spot)

________________________________________

List Specialty Passes:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Current Parent Permission Form Signed after 9/1/09 must be on file. Also sign Reverse Side of this form.

Download date unknown PDF

Parents signature

_______________________

Date:

_________

*At the conclusion of Evaluation Day you will be MAILED your placement information. Please put any special requests in writing to cheer@kehlersgym.com. Thank you for NOT attempting to discuss concerns at the gym that day.

Staff Only Notes: Standing

Running

Cheer/Motions

Jumps /Flexibility

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