Participant Application Online

Participants Application

Information
Participant Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Birthdate*
Gender*
- Male
- Female
Height*
#'#"
Weight (lbs)*
Shoe size (bowling)*
T-shirt Size*
How many years has Participant attended MDO?*
- First Time
Parent/Guardian Name*
First Last
Relationship to participant*
Parent, grandparent, aunt/uncle, etc.
Parent Email*
Phone/VP*
Cell/Text*
Communication Preference*
- ASL
- Signed English
- Total Communication
- Oral
Emergency Contact
Name*
First Last
Relationship to participant*
Grandparent, aunt/uncle, friend, etc.
Phone/Text*
School Information
As of May 2023
For Opening Ceremony-Please enclose/attach recent photo of Participant
School name*
School address*
City State
Grade*
Mascot
School Color
HS Graduation Year
Please enter a number from 2020 to 2035.
Arrival / Departure Information
Participants wanting to drive or ride with driving Participants MUST submit permission form before arriving.
Participants do not become responsibility of MDO until AFTER registration.
Participants may not leave until AFTER Closing Ceremony.
I will arrive on*
at (Time)
: Hours
Minutes
Which ride to MDO?*
- Car
- Plane
- Train / Bus
Driver name*
First Last
Other riders
Airline name*
Flight #*
Ticket #
Station*
What name station that participant will arrive at
Train / Bus #*
Ticket #
I will leave on*
at (Time)
: Hours
Minutes
Which ride to HOME?*
- Car
- Plane
- Train / Bus
Driver name*
First Last
Other riders
Airline name*
Flight #*
Ticket #
Station*
What name station that participant will leave from
Train / Bus #*
Ticket #
Participant Code of Conduct
As an MDO Participant, I will
- Be Respectful, Cooperative, and contribute positively to the MDO experience
- Practice excellent Sportsmanship, strong Teamwork, and outstanding Character
- Listen and follow all directions from my Coach and all other MDO Staff
- Keep my hands to myself, NO hitting, fighting, or bullying
- Have fun, but not at the expense of others
- Have a good attitude and use appropriate language (NO obscenity)
- Respect MDO property, Life Adventure Center property, Woodford County Rec Center property
- NOT bring ANY electronic devices (cell phone, IPad, computers, game devices, spinners, etc) to MDO
- NOT engage in sexual activity
- NOT use, possess, distribute, sell, or be under the influence of alcohol, drugs, or cigarettes
- NOT possess weapons of ANY kind
- NOT participant in acts of vandalism of any kind
IF I violate the MDO Code of Conduct, I will accept the consequences, which MAY include
- Losing competition time
- Losing event and entertainment time
- Losing medals and record standing
- Being disqualified for Mr and Miss Olympian competition (High School Participants)
- Time Out
- Writing letters of apology
- Paying for damages
- Having my parents called
- Being sent home (at parents expense)
- NOT being allowed to return to MDO (for serious offenses)
- Prosecution if situation warrants (unlawful activity out of MDO hands)
Participant Signature*
Parent Signature*
Authorizations - Read Carefully
Advance knowledge*
The Deaf Youth Sports Festival/MDO MUST have advance knowledge of special needs for your child. This information
will be treated confidentially and used to make preparations. We will not use this information as a basis for rejecting this
application. I understand that if MDO is unable to appropriately provide for my child BECAUSE I HAVE NOT
PROVIDED THE NECESSARY INFORMATION, my son/daughter may be sent home AT MY EXPENSE.
I have read and agree.
Over the Counter medications*
I give permission for Over the Counter medications (such as Tylenol, Benadryl, etc) to be administered to my child if
needed. I have informed MDO of any and ALL allergies and reactions.
I have read and agree.
Emergency medical*
The Deaf Youth Sports Festival has my permission to use emergency medical measures in the event of an emergency
I have read and agree.
Leave the grounds*
I give permission for my child to leave the grounds and its facilities with authorized staff for outings and trips.
I have read and agree.
Pictures, name, and other*
I agree that The Deaf Youth Sports Festival has my permission to use pictures, names, and other art forms depicting
myself and/or my child in MDO publications and promotions.
I have read and agree.
Parent Signature*
Date*
Health / Special Needs Information
To expedite registration and ensure medications are administered correctly, please complete all information below and list all medications to be given at MDO on the Participant Medical Information Check-In Form. Thank you for your patience and understanding to help us make MDO a fun and safe experience for all.
Physician's Name*
First Last
Physician's Phone #*
Physician's Address*
Street Address Address Line 2 City State ZIP Code
Health Insurance Company*
Policy #
Special Needs
- Tubes in ears
- Hearing Aids
- Cochlear Implant
Special Needs
- Special diet / food restrictions
- Physical / Sports limitations
- Heart procedures / surgeries
- Other conditions
- Social, emotional, behavioral
- Other information
- No any conditions
Special diet / food restrictions*
Physical / Sports limitations*
Heart procedures / surgeries*
Other conditions*
Social, emotional, behavioral*
Other information*
Medication*
All medications will be administered based on the prescription label instructions unless a doctor statement is
provided authorizing something different. It is the Parent/Guardian’s responsibility to provide written doctor’s
authorization of changes or they will be administered based on the prescription label instructions.

I affirm that the medication, health, and special needs information listed above is accurate.
I understand and agree with the above statement.
Parent / Guardian Signature*
Date*
Participant Medical Information
Date of last tetanus shot*
Immunizations / shots up to date?*
- Yes
- No
Allergies?*
- Yes
- No
List allergies*
(Food, medicine, insects, plants, etc)
Taking medication at MDO?*
- Yes
- No
How many medication?*
If more than 10 medications needs, please email to the MDO team.
Please enter a number from 1 to 10.
Medication information 1*
Name of Medication: Strength (mg, mcg, etc): Amount (1 tablet, 1 tsp, etc.): Prescribing Dr’s name: Receives medication (check all that apply) -Special Instructions: -Breakfast: -Lunch: -Dinner: -Bedtime: -Other:
Medication information 2*
Name of Medication: Strength (mg, mcg, etc): Amount (1 tablet, 1 tsp, etc.): Prescribing Dr’s name: Receives medication (check all that apply) -Special Instructions: -Breakfast: -Lunch: -Dinner: -Bedtime: -Other:
Medication information 3*
Name of Medication: Strength (mg, mcg, etc): Amount (1 tablet, 1 tsp, etc.): Prescribing Dr’s name: Receives medication (check all that apply) -Special Instructions: -Breakfast: -Lunch: -Dinner: -Bedtime: -Other:
Medication information 4*
Name of Medication: Strength (mg, mcg, etc): Amount (1 tablet, 1 tsp, etc.): Prescribing Dr’s name: Receives medication (check all that apply) -Special Instructions: -Breakfast: -Lunch: -Dinner: -Bedtime: -Other:
Medication information 5*
Name of Medication: Strength (mg, mcg, etc): Amount (1 tablet, 1 tsp, etc.): Prescribing Dr’s name: Receives medication (check all that apply) -Special Instructions: -Breakfast: -Lunch: -Dinner: -Bedtime: -Other:
Medication information 6*
Name of Medication: Strength (mg, mcg, etc): Amount (1 tablet, 1 tsp, etc.): Prescribing Dr’s name: Receives medication (check all that apply) -Special Instructions: -Breakfast: -Lunch: -Dinner: -Bedtime: -Other:
Medication information 7*
Name of Medication: Strength (mg, mcg, etc): Amount (1 tablet, 1 tsp, etc.): Prescribing Dr’s name: Receives medication (check all that apply) -Special Instructions: -Breakfast: -Lunch: -Dinner: -Bedtime: -Other:
Medication information 8*
Name of Medication: Strength (mg, mcg, etc): Amount (1 tablet, 1 tsp, etc.): Prescribing Dr’s name: Receives medication (check all that apply) -Special Instructions: -Breakfast: -Lunch: -Dinner: -Bedtime: -Other:
Medication information 9*
Name of Medication: Strength (mg, mcg, etc): Amount (1 tablet, 1 tsp, etc.): Prescribing Dr’s name: Receives medication (check all that apply) -Special Instructions: -Breakfast: -Lunch: -Dinner: -Bedtime: -Other:
Medication information 10*
Name of Medication: Strength (mg, mcg, etc): Amount (1 tablet, 1 tsp, etc.): Prescribing Dr’s name: Receives medication (check all that apply) -Special Instructions: -Breakfast: -Lunch: -Dinner: -Bedtime: -Other:
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Participants Application

Information

Emergency Contact

School Information

Arrival / Departure Information

Participant Code of Conduct

Authorizations - Read Carefully

Health / Special Needs Information

Participant Medical Information