DREAM TEAM REGISTRATION - ADULT
The
Dream Team
PlayBall!
What is the Dream Team?
The Dream Team is a co-ed baseball league formed to include youths, teens and young adults ages 8-26 with disabilities. Dream Team players are paired with partner players from local baseball and softball teams. The partner players will play alongside Dream Team players and provide assistance, as needed.
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Dream Team
Traverse City
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information!
First Pitch!
Pending registration, Dream Team play will begin in May and will conclude the end of June. Dream Teams may play up to 6 games. Games will be located at GT Civic Center in Traverse City. There is
no cost
to participate. Yes, it's really FREE! Go to www.dreamteamnmi.com
Complete the registration form below and send to: dreamteamnmi@gmail.com or
Dream Team, PO Box 4424, Traverse City, MI 49685-4424
Player Name:
Gender
Female
Male
Age:
Address:
Jersey Size:
Youth/Adult
Youth
Adult
City, State, Zip Code
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name:
First Name
Last Name
Cell:
Format: (000) 000-0000.
Email:
example@example.com
Address (if different from player):
City, State, Zip Code
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Player's School:
Teacher:
Please list previous baseball experience:
**Special request or accommodations needed:
YES! I'm interested in volunteering!
Coach
Team Parent
Player Assistant
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MEDICAL RELEASE
NOTE: To be carried by any Regular Season or Tournament
Team Manager
Player:
Date of Birth:
-
Month
-
Day
Year
Date
Gender (M/F):
Parent (s)/Guardian Name:
Relationship:
Parent (s)/Guardian Name:
Relationship:
Player's Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone:
Format: (000) 000-0000.
Work Phone:
Format: (000) 000-0000.
Mobile Phone:
Format: (000) 000-0000.
PARENT OR GUARDIAN AUTHORIZATION:
In case of emergency, if family physician cannot be reached, I hereby authorize my child to be treated by Certified
Emergency Personnel. (i.e. EMT, First Responder, E.R. Physician)
Family Physician:
Phone:
Format: (000) 000-0000.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Hospital Preference:
Parent Insurance Co:
Policy No.:
Group ID#:
If parent(s)/guardian cannot be reached in case of emergency, contact:
Name
Phone
Format: (000) 000-0000.
Relationship to Player
Name
Phone
Format: (000) 000-0000.
Relationship to Player
Please list any allergies/medical problems, including those requiring maintenance medication. (i.e. Diabetic, Asthma, Seizure Disorder)
Rows
Medical Diagnosis
Medication
Dosage
Frequency of Dosage
1
2
3
4
Date of last Tetanus Toxoid Booster:
The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.
Mr./Mrs./Ms. Authorized Parent/Guardian Signature
Date:
-
Month
-
Day
Year
Date
WARNING: PROTECTIVE EQUIPMENT CANNOT PREVENT ALL INJURIES A PLAYER MIGHT RECEIVE WHILE PARTICIPATING IN BASEBALL/SOFTBALL.
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Dream Team Consent Form
Any information written on this form will be held in confidence. Our coaches need to know these details in order to meet the specific needs of your child. I give permission for my child to attend for training and playing sessions.
Child's Full Name:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Tel No.
Format: (000) 000-0000.
Age
Date of Birth
-
Month
-
Day
Year
Date
Gender:
Male
Female
Emergency Person
Contact Number
Format: (000) 000-0000.
Relationship to player
GP/Doctor's Name
GP / Doctor's Tel No
Format: (000) 000-0000.
Details of any known special dietary requirement/allergies /medical conditions
Any other special needs, requirements, directions, that would be helpful for the coaches to know about
I will inform the coaches of any important changes to my child's health, medication or needs, and also of any changes to our address or phone numbers given.
In the event of illness, having parental responsibility for the above-named child, I give permission for medical treatment to be administered where considered necessary by a nominated first aider, or by suitably qualified medical practitioners. If I cannot be contacted and my child should require emergency hospital treatment, I authorize a qualified medical practitioner to provide emergency treatment or medication.
I confirm that all details are correct to the best of my knowledge and I can give parental consent for my child to participate in & travel to all activities.
Signature of Parent/Guardian
Date
-
Month
-
Day
Year
Date
Print Name
Dream Team Photo/Video Consent
Player Name:
Date:
-
Month
-
Day
Year
Date
Yes, I grant permission for the Dream Team to take photos and/or video for the purpose of promoting the Dream Team program. And I do understand the photos/video will be posted on Dream Team's social media pages and promotional print materials.
Signature of Parent/Guardian:
Please contact Dayna Ryan with any questions at 231-883-5747. Thank you.
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DREAM TEAM PLAYER BIO
NAME:
AGE:
SCHOOL:
DOB:
PREVIOUS SPORTS/EXPERIENCE:
BEHAVIORAL HELPFUL HINTS / SUPPORTS REQUIRED:
ADDITIONAL INFORMATION TO SHARE
FAMILY MEMBERS:
PETS:
YOUR FAVORITES:
ATHLETE:
FOOD:
SPORTS TEAM:
TV SHOW:
CLASS AT SCHOOL:
MOVIE:
VIDEO GAME:
ACTOR:
COLOR:
SONG/BAND:
WHAT DO YOU WANT TO BE WHEN YOU GROW UP?
PLEASE ADD ANYTHING ELSE YOU WISH TO SHARE: (Do you play an instrument/play other sports/have a job/have a hobby?):
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Parks and Recreation
GRAND TRAVERSE
COUNTY
Accident Waiver and Release of Liability for
ADULTS
I acknowledge that this event is a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include but are not limited to, those caused by the terrain, facilities, temperature, weather, condition of the athlete's equipment, vehicular traffic, actions of other people including but not limited to volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event and lack of hydration. If applicable, hazards may be cause by water currents or waves and other water related hazards. I hereby assume all the risks of participating in this event.
I certify that I am physically fit, have sufficiently trained for participation in this event, and have been advised otherwise by a qualified medical person.
I acknowledge that this Accident Waiver and Release of Liability form will be used by Grand Traverse County and the event holders, sponsors, and organizers and that it will govern my actions and responsibilities at said events.
In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns to: (A) Waive, Release, and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter accrue to me, including as to my traveling to and from this event, the following entities or persons: Grand Traverse County, its elected and appointed officials, employees and volunteers, and representatives and agents, and others working or acting on behalf of Grand Traverse County; and to the extent permitted by law (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of or relating to my attendance at or participation in this event.
I hereby consent to receive medical treatment, which may be deemed appropriate in the event of injury, accident, and/or illness during this event.
I hereby certify that I have read this document and understand and agree to its content.
Name:
Age:
Signature:
Date:
-
Month
-
Day
Year
Date
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