Panther Dance Team
2008 - 2009 Application
***Please attach a recent non-returnable photograph along with application***

Name:________________________________________________   Social Security:____________________

Address: ____________________________________________________________ Email Address:__________________________

City: ________________________________  State: _______ Zip: ____________     Cell Phone: ____________________________

Emergency Contact:
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:_____________________________________________________________________________________ 

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Why are you interested in becoming a member of the Panther Dance Team? ___________________________________________________

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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 2008 - April 2009, and will not graduate before May 2009.

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 Member’s Responsibilities (available on the Dance Team’s web site, http://www.danceteam.uwm.edu). A parent’s 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: __________

Parent’s Signature (If Needed): ____________________________________________ Date: __________

 

Return to:

Panther Dance Team

Union Box 101, PO Box 413

Milwaukee, WI 53201-0413