CHSAA, UCA, and
UDA Score Sheets will
be used
Starting @ 10 am
THE COUNTY CHALLENGE
COMPETITION
Open to Middle School, High School Freshmen, JV, Varsity, Coed Cheer, Dance, and All Star Dance Teams
$250 Team Fee Cheer
$200 Team Fee Dance
Late Registration $30 late fee added to team fee
Will follow CHSAA High School State Rules
SCHOOL DIVISIONS – Dance (please check division)
___ Varsity
VARSITY TEAMS MAY ENTER ONE OR TWO CATEGORIES.
___Jazz (all class)
___Hip Hop (all class)
___Pom (Large: 15 or more dancers)
___Pom (Small: no more than 15 dancers)
___ Junior Varsity
JUNIOR HIGH AND JUNIOR VARSITY TEAMS MAY ENTER ONE OR TWO CATEGORIES
__ POM
__ JAZZ
__ HIP HOP
___ All Star
(Tiny: 6 years & younger; Mini: 9 years & younger; Youth: 12 years & younger; Junior: 15 years
& younger; Senior: 18 & younger; Open: 14 years & younger)
__ POM
AGE DIVISION: __________________
__ JAZZ
AGE DIVISION: __________________
__ HIP HOP
AGE DIVISION: __________________
Total # of Participants __________ Total for a Team is $200
Number of Coaches Attending Competition ______________
Head Coach’s Name__________________________________________________
Address,City/State/Zip________________________________________________________________
Contact Phone Number________________________________________________
Email_______________________________________________________________
Payment – please circle one
Credit Card
Cash
Check
Name of Card Holder__________________________________________________
Card # __________________________________ Exp _______Sec Code ________
Check # _____________Please make check payable to County Cheer Booster Club
Total Amount Paid ________________ Return Registration form to: Attn: Nicole Gambatese c/o
DCHS 2842 Front St Castle Rock, CO 80104.
* You can also pay online at www.countycheer.com, look for the competition link.
SCHOOL DIVISIONS – Cheer (please check division)
Division Grade # of Participants
__ Junior High 8th grade and Below 5-30 members
__Freshman 9th grade and below 5-35 members
__Junior Varsity 12th grade and below 5-35 members
__Varsity 5A 12th grade and below 1-25 female members
__Varsity 4A 12th grade and below 1-25 female members
__Varsity 3A 12th grade and below 1-20 female members
__Varsity 2A 12th grade and below 1-16female members
__Coed Varsity 4A/5A 12th grade and below 1-25 members, 1 male+
__Coed Varsity 2A/3A 12th grade and below 1-20 members, 1 male+
Total # of Participants __________Total for a team is $250
Number of Coaches Attending Competition ______________
Head Coach’s Name__________________________________________________
Address,City/State/Zip_______________________________________________________________
Contact Phone Number________________________________________________
Email_______________________________________________________________
Payment – please circle one
Credit Card
Cash
Check
Name of Card Holder__________________________________________________
Card # __________________________________ Exp _______Sec Code ________
Check # _____________Please make check payable to County Cheer Booster Club
Total Amount Paid ________________ Return Registration form to: Attn: Nicole Gambatese c/o
DCHS 2842 Front St Castle Rock, CO 80104.
* You can also pay online at www.countycheer.com, look for the competition link.
GIVE A COPY OF THIS FORM TO EVERY PARTICIPANT
MEDICAL RELEASE AND LIABILITY FORM
I.
II.
III.
IV.
I, undersigned parent or guardian, do hereby grant permission for my child whose name is
________________________________ and hereinafter shall be referred to as "participant" to participate in the
County Challenge Competition. In order that participant may receive necessary medical treatment in the event of
injury or illness, I hereby hold the Director and its representatives harmless in the exercise of the authority.
I further acknowledge and understand and agree that in taking part in this competition, there is the possibility of
physical illness or injury (minimal, serious, or catastrophic) and the participant is assuming the risk of such injury
by participating.
I further agree to hold harmless Douglas County High School, including its directors, officers, staff employees of
which conduct the competition, Douglas County High School in which the competition is being conducted and for
illness or injury incurred by participating during the course of the competition.
Emergency Treatment
To All Parents:
Since the malpractice question has come to the forefront, many
hospitals and doctors will not treat a child without parent’s consent (unless a matter of life or death). It is
requested that you complete the information below so that if your child requires a visit to the hospital while under
the supervision of the school, this will allow the hospital to treat the injury.
EMERGENCY INFORMATION
Name:______________________________________
Sex:M___F____
Grade:____________________
Age:______________Date of Birth:_____/_____/______ Parent or Guardian Name_________________________________________
Home Phone Number____________________________________ Home Address_________________________________________
Cell Phone Number_________________________________________
Another Person to Contact__________________________________________________
Relationship__________________________Phone Number_______________________
Insurance Name__________________________________________________________ Policy and Group Numbers__________________________________________________
ALLERGIES_____________________________________________________________
Consent Statement: Authorizing Treatment
Guardian Signature_______________________________________________Date______________