sovaglobe.jpg - 2758 Bytes Special Olympics Virginia

SPECIAL OLYMPICS VIRGINIA REGISTERED TRAINING PROGRAM FORM (R.T.P.)
DIRECTIONS: All information should be filled out completely by the Head Coach. Return the completed form within the first month of the season to your Section Director: Athletes may not be eligible for State Competitions unless registered with this form prior to State Competition registration deadlines.

NORTHWEST
Daniel Leake
P.O. Box 1906
Harrisonburg, VA 22801
dleake@specialolympicsva.org		 CENTRAL
Tina Andes
URBAN PROGRAM
Floyd Miller
3212 Skipwith Rd., Suite 100
Richmond, VA 23294
tandes@specialolympicsva.org
fmiller@specialolympicsva.org		 NORTH
Beth Frank
11350 Random Hills Rd., Suite C140
Fairfax, VA 22030
bfrank@specialolympicsva.org
SOUTHWEST
Nancy Morehouse
P.O. Box 153
Blacksburg, VA 24063
nmorehouse@specialolympicsva.org		 NORTH CENTRAL
Danielle Pokusa
1931 Plank Rd., Suite 106
Fredericksburg, VA 22401
dpokusa@specialolympicsva.org		 SOUTHEAST
Carl Earnshaw
184 Business Park Dr., Suite 202
Virginia Beach, VA 23462
cearnshaw@specialolympicsva.org

RTP Form can be downloaded from the SOVA website at www.specialolympicsva.org

For office use only

RTP#: ______________________________________________________________
Date Received: ______________________________________________________________
Season: ______________________________________________________________
Year: ______________________________________________________________
Revision

PLEASE PRINT OR TYPE ALL INFORMATION

Head Coach Name: Area # : Local:
Street Address:
City/State/Zip:
Home Phone: Work Phone :
E-mail address:

SPORT COMPONENT (CIRCLE ONE SPORT ONLY)

ALPINE SKIING EQUESTRIAN POWERLIFTING SPEED SKATING (ICE)
Aquatics (Swimming) FIGURE SKATING (ICE) ROLLER SKATING SWIMMING SKILLS
ATHLETICS (TRACK & FIELD) FLOOR HOCKEY SAILING TENNIS
BASKETBALL - SKILLS GOLF SKILLS (Level 1) SOCCER - SKILLS TENNIS SKILLS
BASKETBALL HALF-COURT GOLF - LEVEL 2 SOCCER (5 V 5) VOLLEYBALL - SKILLS
BASKETBALL FULL COURT GOLF - LEVEL 3 SOCCER (5 V 5) UNIFIED VOLLEYBALL - TEAM
UNIFIED BASKETBALL FC GOLF - LEVEL 4 SOCCER (7 V 7) VOLLEYBALL- TEAM-UNIFIED
BOCCE GOLF - LEVEL 5 SOCCER (7 V 7) UNIFIED WHEELCHAIR ATHLETICS
BOWLING GYMNASTICS SOFTBALL - SKILLS YOUNG ATHLETE PROGRAM
CHEERLEADING MOTOR ACTIVITIES SOFTBALL - TEAM  
CYCLING NORDIC SKIING SOFTBALL - TEAM-UNIFIED  

Special Olympics requires a minimum eight week training period prior to State Level Competition.
Please indicate the following information:

Starting Date of Training: Ending Date of Training:
Typical Weekly Training/Practice Day(s):
Typical Training/Practice Time(s):
Training Site: Facility: City:

ASSISTANT COACH ROSTER (Form Revised 12/01/04)

Name:
Address:
City, State:
Home Phone:
Work Phone:
E-mail address:
Name:
Address:
City, State:
Home Phone:
Work Phone:
E-mail address:
Name:
Address:
City, State:
Home Phone:
Work Phone:
E-mail address:
Name:
Address:
City, State:
Home Phone:
Work Phone:
E-mail address:
READ THIS NOTICE AND PLEASE TYPE OR PRINT ALL INFORMATION NEATLY.

All athletes on roster MUST have a current Application for Participation and Official Special Olympics Release Form on file with Special Olympics Virginia (SOVA). All unified partners MUST have a current Application for Participation (Unified Partner Form) on file and must update this form every three years with SOVA. If forms are not current or the athlete’s name does not appear on the Master Athlete List for this sport, attach updated forms to this RTP before sending it to the Section Director. Current Unified Partner Forms should be on file or attached to this form.

ATHLETE/PARTNER ROSTER

CHECK ONE NAMES OF ATHLETES/PARTNERS GENDER AGE GROUP
Athlete Partner Male Female 2 - 7 8 - 15 16 - 21 22 +
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RTPs are due by the end of the first month of the season. Any athlete applications not current in the Harrisonburg office should be updated before the athlete or partner participates in the program. Questions regarding the status of an Application can be directed to the Harrisonburg office at 540-433-7475 or 800-526-6133. Totals 2 - 7 8 - 15 16 - 21 22 +
Athlete Male
Athlete Female
Partner Male
Partner Female