Name:________________________________________________       Age_______

School:_______________________________________________    Grade_______

Address:____________________________________________________________

City:_____________________________________ Zip code:___________________

Home Phone:_______________________  Family cell phone:__________________

Family email: _________________________________@______________________

Emergency Contact:___________________________________________________

Phone:___________________________Cell Phone___________________________

Description of disability / special needs :___________________________________

_____________________________________________________________________

Have you played on Team PASA in past seasons?      Yes          No

 

The County and P.A.S.A. assume no liability for injury and damages arising from participation in this program. All activities present inherent risks and hazards which the participant assumes. I hereby accept any risk associated with participation in this program. To the best of my knowledge there are no physical or other conditions which will interfere with my child’s participation. I hereby approve my child’s participation in this program and consent to emergency medical treatment for my child on my behalf. I understand that the photographs taken of Recreation Programs may be used by Montgomery County Department of Recreation.

Signature:________________________________________________________________Date__________________

 

Print Name:_______________________________________________________________

TEAM PASA ( Potomac Adaptive Sports Association) is offered in a partnership with Montgomery County Department of Recreation and The Potomac Community Center.

Sundays,

10:00-11:30

Potomac Community Center 11315 Falls Road

April 6—June 1

PASA is a partnership program with SOMO—open to all children with special needs ages 6-18.

T-ball is offered to athletes age 6– 12 and Intermediate/High School Softball to athletes in middle and high school.

 

Send in this registration form and $20.00 PASA fee to:

Special Olympics MO  - PO Box 1809 Rockville MD 20849         

Our Middle School and High School Softball Skills League trains with volunteers from the Bullis and Churchill High School Baseball teams to learn the basics of softball.

Led by Coach Rill, our softball training league prepares our young softball team for competition in the Seniors Softball Program. We need volunteers to coach and play in this program. Contact Pam Yerg at jeyclan@verizon.net.