Mighty Minds League - Registration

Mighty Minds League - Athlete Registration

Register a child athlete and share the information coaches need for participation, support, safety, and permissions.
Child Information
Child’s Full Name

First NameMiddle NameLast Name
Preferred Nickname
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Gender

Self-describe
Parent/Guardian Information
Parent/Guardian Name

First NameLast Name
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Emergency Contact
Emergency Contact Name

First NameLast Name
Relationship to Athlete
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical & Safety Information
Diagnosis you would like us to know about
Medical conditions
Allergies

Other
Carries an EpiPen or emergency medication?
Physical limitations or restrictions
Current medications affecting participation
Communication
How does your child communicate?

Other
Best way to give instructions
Direction level understood
Sensory Needs
Sensitive to

Other
What helps your child stay calm?
Helpful sensory tools

Other
Behavior & Support
What motivates your child?

Other
Behaviors we should know about
Strategies that work best when frustrated
Three things that help your child succeed
Sports Experience
Played organized sports before?
Sports of interest

Other
Child’s strengths
Skills to work on
Independence
Requires one-on-one assistance?
Toilet independent?
Tends to wander or elope?
Can participate without a parent present?
Parent Goals
Goals for your child
Anything else coaches should know?
Permissions
Medical Emergency Authorization
Liability Waiver
Photo/Video Permission
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Mighty Minds League - Athlete Registration

Child Information

Parent/Guardian Information

Emergency Contact

Medical & Safety Information

Communication

Sensory Needs

Behavior & Support

Sports Experience

Independence

Parent Goals

Permissions