DREAM TEAM REGISTRATION - MINORS
The Dream Team Play Ball!
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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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:
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 Certifled
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
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Child's Full Name:
Address
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
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
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Signature of Parent/Guardian
Date
-
Month
-
Day
Year
Date
Print Name
Dream Team Photo/Video Consent
PlayerName
Date:
-
Month
-
Day
Year
Date
Signature ofParent/Guadan
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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
Parent-Guardian Waiver for Minors Accident Waiver and Release of Liability
The undersigned parent and natural guardian or legal guardian, does hereby represent that he/she is, in fact, acting in such capacity, and agrees to the fullest extent permitted by law to save, hold harmless and indemnify Grand Traverse County, their elected and appointed officials, employees and volunteers, from any and all liability, loss, cost, claim or damage whatsoever, including bodily injury or death, which may be imposed upon or incurred by Grand Traverse County because of the participation of the minor in this event. By signing below, you also agree to release said parties in this regard on behalf of both the minor and parents or legal guardian.
Consent to Medical Treatment of Minor
If the applicant is under 18 years of age, the parents or guardians must execute this document.
I hereby authorize any duly authorized doctor, emergency medical technician, paramedic, nurse, hospital, or other medical facility to treat said minor for the purpose of attempting to treat or relieve any injuries received by, or illness of, said minor while he/she is/was a participant or observer at the event named below.
I authorize any licensed physician to perform any procedure, which he/she deems advisable in attempting to treat or relieve any injuries to, or illness of, said minor that he/she may encounter during any necessary operation.
I consent to the administration of anesthesia to said minor as deemed advisable by any licensed physician.
The undersigned parent or natural guardian or legal guardian of said minor does hereby represent that he/she is, in fact, in such capacity and to the extent permitted by law agrees on his/her behalf, and that of the minor, to save, hold harmless and indemnify Grand Traverse County, its elected and appointed officials, employees and volunteers, from any and all liability, loss, cost, claim, or damage whatsoever that may be imposed upon or incurred by said parties because of the participation of the minor in the event shown, and does release said parties on behalf of both the parents or legal guardian.
Rows
Parent/Guardian Name (Please print)
Parent/Guardian Signature
1.
2.
3.
4.
Preview PDF
Submit
Should be Empty: