Forms, Waivers and Releases necessary for participation
in MASD Sports and Recreation programs are available
by clicking the links below. They are available
in Adobe Acrobat (.PDF) format. If you do not
have an Adobe Acrobat Reader, you may download
a free version from Adobe by clicking here.
Register for Special
Olympics Programs
Register
for Physically Challenged Programs
Print
the program schedule below for detailed information
on the currently offered programs.
2009
- 2010 Winter-Spring Special Olympics Schedule.
2009
- 2010 Winter - Spring Special Olympics Registration.
Time Out Brochure http://mesaaz.gov/parksrec/timeout/default.aspx
There are 2 ways to Register for Current Special
Olympics Programs:
1.
Log onto www.mesaaz.gov
to use Web Trac (the direct link to the web
trac information is https://secure.cityofmesa.org/registration/register.html)
2.
Stop by in person at the City of Mesa Adaptive
Parks and Recreation office located at 200 S.
Center Street, Bldg #1, Mesa, AZ 85210
All Athletes
must have completed a waiver,registration form
and current Special Olympics Arizona physical
on file with the City of Mesa prior to the first
day of practice.
If you are a new athlete or have an expired
Arizona Special Olympics Physical, print Front
and Back of the Arizona Special Olympics Medical
Release Form. Please fill out in its entirety.
The Medical Release Forms must be filled out
by a Physician. To see if you have a current
physical, contact Jacquie Gallo ( jacquie.galloi@mesaaz.gov
) or call 480-644-4948.
Arizona
Special Olympics Medical Release Form
Arizona Special Olympics Medical Release Form
(Front) Arizona Special Olympics Medical Release
Form (Back) Mail or Fax the above listed information
to the City of Mesa Office. City of Mesa Attn:
Jacquie Gallo 200 S. Center Street, Building
1 Mesa, AZ 85210 Fax: 480-644-3369 You will
not get a call to verify enrollment. Please
make a note of the practice times and locations
and show up for some fun!
Mail or Fax the above listed
information to the City of Mesa Office.
City of Mesa
Attn: Jacquie Gallo, 200 S. Center Street, Building
1
Mesa, AZ 85210
Fax: 480-644-3369
You will not get a call to verify enrollment.
Please make a note of the practice times and
locations and show up for some fun!
How to Register for Current Programs
for People with Physical Disabilities:
1.
Click on the link below and print out the packet.
Fill out and sign the Registration Wavier Form.
.
Physically
Challenged Program Schedule -Winter-Spring 2010
Athlete
Request Form Summer-Fall 2009
2. If
you are new to the sports programs, please click
the link below to print the MASD Liability Waiver
Form. Sign and Date the Waiver. If the participant
is a minor and/or has a legal guardian, both
signatures are required.
Media
Release Form
3.
Review the athlete’s appropriate Disabled Sports
Organization (see links
page) and complete the appropriate Medical
Physical Form in its entirety. The Medical Physical
Form must be filled out by a Physician. To be
a competitive athlete, each participant must
have a current medical physical each year. The
physicals are good January through December
of each year. To see if you have a current physical,
contact Lane Jeppesen
( lane@mesadisabledsports.com
) or call 480-835-MASD.
Blaze
Sports Physical
WSUSA
Physical 1
WSUSA
Physical 2
4.
Mail or Fax the above listed information to
the Arizona Disabled Sports office.
MASD / AzDS
Attn: Registration
59 East Broadway Road
Mesa, AZ 85210
Fax Line: 480-610-2257
5.
Please make note of the practice times and locations
and show up for some fun!
