Special Olympics Floor Hockey Winter 2019
Athlete's First Name *
Your answer
Athlete's Last Name *
Your answer
Male or Female *
Athlete's Age. Must be 8 and up *
Your answer
Athlete Shirt Size *
Required
Parent/Guardian's First Name *
Your answer
Parent/Guardian's Last Name *
Your answer
Parent/Guardian Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Parent/Guardian's Mobile telephone number *
Best in case of emergency
Your answer
E-mail address. Indicate "none" if none available *
Your answer
Please describe the player's diagnoses and/or special needs so we can do our best to accommodate. Please indicate list of medical conditions/allergies that we should be aware of. *
Your answer
Please indicate if the player needs assistive device such as wheelchair, braces, walker, etc. *
Your answer
I understand that Parent/Guardian for new players must be present at practice/games *
Required
Special Olympic's Three Year Medical Form required to participate at practices and competition *
Medical is good for 3 years. Form is available on website.
Initial Sessions: 9/21/19, 9/28/19 Practice Dates are: Saturdays Sept: 21, 28 Oct: 5, 12, 19, 26 as well as alternating Saturdays in November & December during league play. *
Practices will be held at Upper Township Primary School Gym from 9:30 am to 11:00 am. League games at Burlington City High School are Saturdays November to December on alternating Saturdays and Stockton University Winter Games January 5th & 6th 2019
Required
Player is required to attend practice sessions, games and tournaments *
Required
I/We give permission for my son/daughter to participate in the Upper Township Challenger Sports Program. If my son/daughter is over the age of 18, I represent that I have legal authority to sign on their behalf. I/We agee to return equipment issued to my child in good condition as when received, except for normal wear and tear. I/We assume all risk of injury due to participation in this sport and release the Township of Upper and Upper Township Challenger Sports for any liability in this regard. I/We give permission to Upper Township Challenger Sports and Township of Upper to display my son's/daughter's photo *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service