For more information about

P.A.S.A.

Potomac Adaptive Sports Association

Call Larry Chloupek at (301) 469-6514

TO REGISTER

AS A SPECIAL OLYMPICS ATHLETE:

Call:

Special Olympics Maryland-Montgomery

Call (301) 924-6965 (Special Olympics Hotline- Box #6 and leave a message for our Medical Director)

Questions?

Pam Yerg (301) 424-3083 / E-mail jeyclan@verizon.net

Potomac Adaptive Sports Association

Adaptive Sports Programs

 For children with disabilities and special needs

Potomac Community Center

11315 Falls Road – Potomac – MD

(301) 983-4471

SPRING T-BALL

Sundays 10-11:30 April 2 - May 21 ,2006

P.A.S.A. is happy to continue our partnership with

Special Olympics MD – Montgomery

P.A.S.A. Registration Form

P.A.S.A. Registration Form

Please complete and return with $20.00 Program Fee to:

PASA - Larry Chloupek – P.C.C. - 11315 Falls Road Potomac MD 20854

Participant:_________________________________________

Age_____ Grade Level ______ School___________________

Address:___________________________________________

City:_______________________ Zip Code:_______________

Home Phone:            (_______)_________________

Daytime Phone:        (_______)_________________

Family E-mail: ____________________@________________

Emergency contact:__________________________________

Phone: (____)____________  Cell Phone (____)___________

Concerns/Disabilities Notes:___________________________

__________________________________________________

The County and P.A.S.A. assume no liability for injury and damages arising from the participation. All activities present inherent risks and hazards which the participant assumes. I hereby accept any risk associated with participation. 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 photographs/video taken of Recreation Programs may be used by the Montgomery County Department of Recreation.

Signature:___________________________________________________

Print Name:__________________________________Date:___________

P.A.S.A. Spring 2006

P.A.S.A. and Special Olympics Maryland – Montgomery

combine forces to bring Adaptive Sports

to children ages 6-15 with Disabilities and Special Needs!

The SPRING T-ball Program

 will focus on skill development and casual games. 

The Program is open to children with disabilities and special needs (ages 6-15). You do not have to be a registered Special Olympic athlete in order to participate.

We will train rain or shine ... our first choice will be to play outdoors, but we can play inside if weather dictates.

Note the later time frame for this program: 10-11:30 AM.

P.A.S.A. players and volunteers should wear comfortable clothing suitable for outdoor play, and supportive sport shoes. Bring a baseball glove if you have one! Our t-ball equipment is limited, but we plan to build it up!

©Volunteers are the Heart of this program. We need volunteer “Buddies” to work with the participants and to play with them in Unified T-ball. Unified Sport is a Special Olympics concept that teams disabled and non-disabled players together to build skills and friendships.

If you are interested in volunteering please complete the section below and mail to Larry Chloupek – P.C.C.

Volunteer Name____________________________________

Address:__________________________________________

City________________________Zip Code_______________

Phone (______)________________

E-mail______________________@__________________

School_________________________________Age_______