SPECIAL OLYMPICS TEXAS
2018 SOTX Houston DynamoMLS Exchange Team
Player Information Packet
Cover Sheet & Checklist
The Following is the Player Information and Application Packet for the 2018 SOTX Houston DynamoMLS Exchange Team.
Player Information
Name: ______
Team/ Delegation Name: ______
Role: Athlete (Traditional Special Olympics Athlete)
Unified Partner (an individual without Intellectual Disability)
Descriptions:
Special Olympics Athlete: An individual with an Intellectual Disability or closely related development disability, which means having functional limitations in both general learning and in adaptive skills such as recreation, work, independent living, self-direction, or self-care. Required to have a SOTX Athlete Enrollment/Medical Form on file with Area Office.
Unified Partner:A hybrid of athlete and volunteer - a person without intellectual disabilities who trains and competes in SOTX part of a Unified team. It is the “giving of time” that puts a Unified Sports® partner into the volunteer category, as well as for safety and liability reasons.Requires full Class A Status which includes Class A Volunteer Application, General Orientation, Protective Behaviors, and Criminal background check (or Minor Reference Form) and a Unified Partner Form. If they unified Partner is new to the program, they must attend the on-line training Coaching Unified Sports and submit certificate of completion; this can be found at
Application Checklist
Coversheet & Checklist
Player Information Forms
Reference Form
Code of Conduct
Forms on all players must submitted by March 9th, 2018.
Please Send/FAX/or Email to the following:
Special Olympics Texas: Houston Office
Attn: Renee Klovenski/Aaron Keith
10777 Northwest Freeway, Ste. 110
Houston, TX 77092
E-mail –
Please contact us at 713-290-0049 with any questions.
Athlete / Unified Partner Expectations & Selection Criteria
For players to be eligible for selection to the 2018 SOTX Houston DynamoRoster, players must demonstrate good sportsmanship and the ability to function well as a part of a team. Players must not only be dedicated to their sport, but must also commit to training weekly for several months, traveling to practice and being involved in other SOTX Houston Dynamo activities as determined by the SOTX Houston Dynamo Staff. In addition, the player must meet all the individual criteria for selection to the team:
Player Expectations & Selection Criteria
- Players must be between the ages of 16-32 years of age.
- To make an exception to the above, you must contact Special Olympics TexasHouston office
- Each player selected must attend all training sessions and matches as outlined by SOTX/Houston Dynamo. This will include attending training sessions on Friday evenings. This may include times that will require players to be away from home and work. Transportation challenges will need to be worked out in advance;
- Players must be able to answer all questions in the affirmative on the Player Information Form;
- Players must have a valid SOTX Medical on file or SOTX Class A Volunteer and Unified Partner Application
- Players must adhere to the Special Olympics Texas Code of Conduct:
- Players must be able to independently manage the activities and skills of daily living, i.e. toileting, showering, personal hygiene, etc.;
- Players must be able to take care of themselves during the course of travel weekends with minimal contact from family members;
- Athletes selected must be able to commit to the SOTX Houston DynamoProgram for two seasons. Unified partners must commit to the SOTX Houston Dynamo Program for one year plus a player option for an additional season.
- A Player may be removed from the team, at any time, for failure to adhere to the principals or fulfill the responsibilities of the criteria as set forth by the 2017 SOTX Houston Dynamo Staff. A Player may also be removed from the team for health and safety issues.
Player Information(please print or type)
Full Legal Name: / (First): / (Middle): / (Last):
What is the potential role of the player? / Athlete / Unified Partner
How many years have you competed in soccer?
Is there a different first name you prefer to go by?
Mailing Address:
City, State, Zip: / Email: / @
Gender: / Male / Female / Date of Birth: / / / /
Preferred Phone: / ( ) / Best Time to Call:
Languages other than English spoken fluently (please list):
Special Olympics Texas Local Program Name:
Additional Contact Information
Parent/Legal Guardian
First Name: / Last Name:
Mailing Address: / City, State, Zip:
Day Phone: / ( ) / Eve. Phone: / ( )
Cell Phone: / ( ) / Fax: / ( )
Best Time to Call: / Email Address: / @
Emergency Contact (if different from above)
First Name: / Last Name:
Mailing Address: / City, State, Zip:
Day Phone: / ( ) / Eve. Phone: / ( )
Cell Phone: / ( ) / Fax: / ( )
Best Time to Call: / Email Address: / @
Relationship toPlayer:
Local Coach (person who coaches your regular team)
First Name: / Last Name:
Mailing Address: / City, State, Zip:
Day Phone: / ( ) / Eve. Phone: / ( )
Cell Phone: / ( ) / Fax: / ( )
Best Time to Call: / Email Address: / @
Sports& Training Information
How many years has the player competed in this sport?
Does playerneed equipment for this sport? / Yes / No
Has this athlete competed previously with the SOTX Houston Dynamo Team? / Yes / No
If yes, what year? / If yes, what role?
Does the athlete have a current SOTX Athlete Medical form?
If yes, what is the expiration date? / Yes / No
Will this player and their support system be willing and able to commit to an intensive training program as prescribed by the 2017 SOTX Houston Dynamo Coaching Staff? / Yes / No
Behavior
Please indicate the most accurate response to ensure the SOTX/Houston DynamoStaff has the most the most complete knowledge and understanding in order to provide a successful experience for the player. Check any boxes listing behavior exhibited by theathlete:
Bites self or others / Elevated sexual interest / Overly dependent on others / Teases others
Cries/becomes upset easily / Exaggerates pain/illness / Overly fearful / Temper tantrums
Difficulty changing routines / Excessive cursing/vulgarity / Pulls own hair or others / Throws objects
Difficulty with authority / Excessive physical touching / Resistant to changes in diet / Uncomfortable in crowds
Difficulty taking direction / Hits self or others / Seeks steady attention / Wanders/runs from group
Elevated emotional needs / Mental health issues / Seeks steady entertainment
Other (please list):
Listdetails to help explain areas above and specific methods to resolve behavior difficulties:
Do you think this player will relate and respond successfully
to an unfamiliar coach and environment? / Yes / No
If no, please explain
Self-Help Skills
Please check the box in each area which best describes this athlete:
Dressing / Grooming / Mealtime / Toileting
Completely independent / Completely independent / Completely independent / Completely independent
Needs minimal assistance / Needs minimal assistance / Needs minimal assistance / Needs minimal assistance
Needs significant assistance / Needs significant assistance / Needs significant assistance / Needs significant assistance
For any skills marked as needing minimal or significant assistance, please provide details to explain needed level of support:
How long does the player take to get out of bed, groom & dress each morning?
In evaluating this players behavior and self-help skills, what level of coach support would be required to be successful?
Would require minimal support to be successful. Playeris relatively independent and/or lives on their own.
Would require moderate support to be successful. Supervision within a group of 4 athletes and 1 coach would be acceptable
Would require significant support to be successful. Supervision on a 1-to-1 basis would be needed.
Medical Overview
Please check all that apply to this athlete:
Allergies / Depression / Hearing Impaired / Special Diet
Asthma / Diabetes / Hepatitis / Surgery (within last year)
Autistic / Down Syndrome / Non-verbal / Uses Cane, Walker, etc.
Broken Bones / Glasses/Contacts / Seizures / Uses Wheelchair
Does this athlete take any medications? If yes, please list below & attach additional sheet if necessary. Yes No
Medication Name / Date Prescribed/Last Changed / Dosage / Times Taken per Day
Is this player self-medicating? / Yes / No
Is this player susceptible to colds, infections, etc? / Yes / No
If female, has this athlete ever menstruated? / Yes / No
If yes, is her cycle consistent? / Yes / No
Travel Experience
Has this playerever traveled by bus? / Yes / NoHas this playerever traveled by airplane? / Yes / No
Has this playerever traveled by train? / Yes / No
Is this player claustrophobic? / Yes / No
Does thisplayerhave physical discomfort when traveling (motion sickness, cramps, and headaches)? / Yes / No
If yes, please explain:
Does this player have emotional discomfort when traveling (homesickness, anxiety, mood swings)? / Yes / No
If yes, please explain:
Has this player taken a long trip without a family member/legal guardian present? / Yes / No
Is the playerable to carry/move their own luggage (suitcase and carry-on) and equipment? / Yes / No
Is this player able to sit and reasonably occupy oneself (movies, music, electronic games, puzzle books, etc) for an extended period of time such as a flight to/from Games? / Yes / No
Additional Information
Please share any additional information that would be helpful to individuals chaperoning this player:- We have read and understand the Player Selection Criteria and expectations of players selected to the 2017 SOTX Houston Dynamo Team, and believe this player meets the requirements as outlined. The information we have provided is true and complete.
- We understand the SOTX Houston Dynamo Staff may remove aplayer from the team if he/she fails to meet the Player Selection Criteria or acts outside the Code of Conduct.
- Please forward all completed materials, including the checklist, to SpecialOlympics Texas: Houston Office.
Signature of Player / Date
Signature of Parent/Legal Guardian / Date
Apparel & Equipment
Please provide preferred sizes for the following items. The jerseys tend to run small:
T-Shirt:
Shorts:
Jersey: (r(run (run sma (run sm
Socks:
Athlete References
Each athlete/unified partner will need to provide three references. Each reference will be contacted. References should be able to answer questions related to at least one of the following areas: training, travel, and daily living skills.
Player Name:Name / Relation to Applicant / Phone # / Email Address
Coach / @
@
@
Why do you want to be a member of the SOTX Houston Dynamo Soccer Team?
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