Juniors Basketball / PASA

Name:________________________________________________       Age_______

School:_______________________________________________    Grade_______

Address:____________________________________________________________

City:______________________________________Zipcode:___________________

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, January 6 – March 2

9:30-11:00

Potomac Community Center 11315 Falls Road

 

PASA is a partnership program with SOMO—open to all children with special needs ages 6-16.

Registered Special Olympics athletes age 10-16 who wish to train on Team PASA and play in the Saturday Juniors Round Robin League must have a current Special Olympics medical on file and complete this PASA Registration

 

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

Special Olympics MO  - PO Box 1809 Rockville MD 20849        

 Our Juniors basketball Round Robin League and the PASA Basketball Program need parents and friends to step forward and offer to manage a team or coach or help coach a team. We are trying hard to offer enough basketball opportunities for all of the junior athletes who have expressed an interest, but need your help to make it all happen. Please email Pam Yerg if you can offer your talent! Thanks! :)

Pam:   jeyclan@verizon.net