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Basketball Team Entry Form

Program Information
County Program Name*
County Coordinator Name*
First Last
County Coordinator Email*
County Coordinator Cell Phone*
Directory Information
This information will be listed on the Team Directory. Only complete this section if the information is different than the County Coordinator.
Name
First Last
Email
Cell Phone
Team 1 Information
Each team must have a unique and distinguishable name.
Team 1 Name*
Team 1 Head Coach Name*
First Last
Team 1 Head Coach Email*
Team 1 Head Coach Cell Phone
Team 1 Type*
- 3-v-3 team
- 5-v-5 team
Team 1 Class*
- Traditional
- Unified
Team 1 Age Group*
- Junior (15 & under)
- Senior (21 & under)
- Master (22 & over)
Team 1 Gender*
- Male
- Female
Do you have a second team to add?*
Team 2 Information
Each team must have a unique and distinguishable name.
Team 2 Name*
Team 2 Head Coach Name*
First Last
Team 2 Head Coach Email*
Team 2 Head Coach Cell Phone
Team 2 Type*
- 3-v-3 team
- 5-v-5 team
Team 2 Class*
- Traditional
- Unified
Team 2 Age Group*
- Junior (15 & under)
- Senior (21 & under)
- Master (22 & over)
Team 2 Gender*
- Male
- Female
Do you have a third team to add?*
Team 3 Information
Each team must have a unique and distinguishable name.
Team 3 Name*
Team 3 Head Coach Name*
First Last
Team 3 Head Coach Email*
Team 3 Head Coach Cell Phone
List Team 3 on Team Directory?*
- Yes
- No
Team 3 Type*
- 3-v-3 team
- 5-v-5 team
Team 3 Class*
- Traditional
- Unified
Team 3 Age Group*
- Junior (15 & under)
- Senior (21 & under)
- Master (22 & over)
Team 3 Gender*
- Male
- Female
Do you have a fourth team to add?*
Team 4 Information
Each team must have a unique and distinguishable name.
Team 4 Name*
Team 4 Head Coach Name*
First Last
Team 4 Head Coach Email*
Team 4 Head Coach Cell Phone
List Team 4 on Team Directory?*
- Yes
- No
Team 4 Type*
- 3-v-3 team
- 5-v-5 team
Team 4 Class*
- Traditional
- Unified
Team 4 Age Group*
- Junior (15 & under)
- Senior (21 & under)
- Master (22 & over)
Team 4 Gender*
- Male
- Female
Do you have a fifth team to add?*
Team 5 Information
Each team must have a unique and distinguishable name.
Team 5 Name*
Team 5 Head Coach Name*
First Last
Team 5 Head Coach Email*
Team 5 Head Coach Cell Phone
List Team 5 on Team Directory?*
- Yes
- No
Team 5 Type*
- 3-v-3 team
- 5-v-5 team
Team 5 Class*
- Traditional
- Unified
Team 5 Age Group*
- Junior (15 & under)
- Senior (21 & under)
- Master (22 & over)
Confirmation
*
I verify the information above is correct.

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Special Olympics Indiana is a not-for-profit organization that provides year-round sports training and athletic competition in more than 20 Olympic-type sports for children and adults with intellectual disabilities, reaching more than 18,000 athletes across Indiana.

Created by the Joseph P. Kennedy Jr. Foundation for the Benefit of Persons with Intellectual Disabilities.

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