2010 USABA Goalball National Championships
For Blind & Visually Impaired Men & Women
Hosted by: Blind Sports Organization
When: Friday-Sunday, June 4-6, 2010.
On Friday, a Coaches’ Meeting will be held at 5:00pm. Opening Ceremonies will begin at 5:30pm. The first games will begin at 6pm. If you are flying, we suggest booking your flight home for Monday.
Where: University of Delaware’s Carpenter Sports Building at the intersection of North College Avenue & Main Street (behind Old College Hall)
Who: Goalball Teams and Pool Players who have participated in at least one regional tournament in 2010 Goalball season. All athletes and coaches must be current USABA members and your local chapter or affiliate. Spectators welcome.
Housing: You must reserve your own room by May 14. BSO has blocked 70 rooms at the Howard Johnson Inn. Please note that breakfast is provided for guests of the hotel. See attached.
Local Transportation: Upon request, BSO will provide transportation between the Howard Johnson Inn and the venue and between the HJ Inn & train station. There will be an additional fee for this service. Please call or e-mail Heidi or Sandy to discuss by May 10.
Are you coming by plane, train, or automobile? (see attached)
Fees: $65 per person (athletes and coaches) + local transportation (if applicable)
Please make checks payable to Blind Sports Organization or BSO.
The registration fee helps offset the costs associated with hosting the event including: facility rental, 3 meals, snacks, equipment, officials, & championship shirts.
Meals: Lunches on Saturday & Sunday and dinner on Saturday will be provided.
Note: a space has been provided on the medical form for you to indicate special dietary requests. We will try to accommodate your needs. Please mark the registration form where indicated.
To Register: Complete the attached forms; call (302) 836-5784; or copy the forms from
www.blindsports.org or www.usaba.org. We must have individual medical and waiver forms for every player and coach. Registration
deadline is May 10.
Info. About Blind Sports Organization – Check www.blindsports.org for more!
Blind Sports Organization was founded in 1974 and is a 501(c)(3), non-profit, community-service organization. Our Chapters promote, provide, and advocate sports and recreation opportunities for blind and visually impaired youth and adults. BSO offers beep-baseball, goalball, judo, walk-run club, bowling, audio darts, and more.
Blind Sports Organization
465 Maplewood Road * Springfield, PA 19064-2901
www.blindsports.org * info@blindsports.org
Phone: (302) 836-5784 * Fax: (302) 836-5084
Co-Directors: Sandy & Heidi White
2010 USABA Goalball National Championships
TEAM REGISTRATION
Please complete one form per team.
Team Name: _____________________________________ Men’s ___Women’s ___
Primary Contact
Name: __________________________________ Phone: ___________________
Address: ___________________________________________________________
____________________________________________________________
E-Mail: ________________________________________________
Note: Please list B1, B2, B3, or B4 under Vision. If any player or coach has a special dietary request due to diabetes, allergy, religious, or other reason, please check the line under Diet beside his/her name and complete the section on his/her medical form.
PLAYERS
NAME Vision Age Diet
1. ____________________________________________ _____ _____ ___
2. ____________________________________________ _____ _____ ___
3. ____________________________________________ _____ _____ ___
4. ____________________________________________ _____ _____ ___
5. ____________________________________________ _____ _____ ___
6. ____________________________________________ _____ _____ ___
Coach(es)/Chaperone(s) (please provide a phone # that will be usable during Nationals)
Name: _________________________________ Phone: _______________ ___
Name: _________________________________ Phone: _______________ ___
Name: _________________________________ Phone: _______________ ___
By May 10, mail your registration form, medical forms, and waivers with payment to: BSO (Nationals), 321 Joy Court, Bear, DE 19701.
2010 USABA Goalball National Championships
POOL PLAYER REGISTRATION
Please complete one form per pool player.
I wish to be placed on a _____ Men’s _____Women’s Team.
Name: __________________________________ Phone: _____________________
Address: ___________________________________________________________
____________________________________________________________
E-Mail: ________________________________________________ Age: _______
Please provide a phone # that will be usable during Nationals: _________________
Emergency Contacts:
Name: _________________________________ Phone: _______________
Name: _________________________________ Phone: _______________
Vision Class
___ Totally Blind (B1)
___ best corrected 20/600 – finger movement; or field less than 5° (B2)
___ best corrected 20/200 – 20/600; or field of 5° to 20° (B3)
___ best corrected 20/70 – 20/200 (B4)
___ Dietary Request - Please specify on the medical form.
By May 10, mail your registration form, medical forms, and waivers with payment to: BSO (Nationals), 321 Joy Court, Bear, DE 19701.
Blind Sports Organization
465 Maplewood Road
Springfield, PA 19064-2901
(302) 836-5784 * www.blindsports.org
WAIVER, RELEASE, and HOLD HARMLESS AGREEMENT
In consideration for being allowed to participate in the USABA Goalball National Championships, hosted by Blind Sports Organization, June 4-6, 2010 at the University of Delaware; I hereby waive, release, and discharge USABA, BSO, and the University of Delaware, including their employees, agents, servants, and instrumentalities from any and all liabilities, causes of action, rights or claims for death, disability, personal injury, property damage, or theft, which may accrue to me as a result of my participation in these events. I also understand that I may be held liable for any damage or loss to the facilities caused by my actions. I will indemnify and hold harmless: BSO and USABA, their officers and volunteers; the University of Delaware and their employees, agents, servants, and instrumentalities from any liabilities, claims, causes of action of any kind, and claims made by other individuals or entities, which may result from any of my actions during my participation in these events.
Print Name of Participant: _______________________________ DOB: __________________
Signature of Participant (or Guardian if under 18): _____________________________________
Print Signed Name: ____________________________________ Date: ___________________
PHOTOGRAPHY RELEASE
I give permission for myself, or my child, to be photographed for education, promotion, or publicity purposes. I understand that the pictures may be used in USABA’s and/or BSO’s newsletters, brochures, press articles, and other publications, as well as on the organization’s website. Names may appear in the caption. No contact information will be provided without my express permission.
Name of Participant: ____________________________________________
Signature: ___________________________________________ Date: ____________________
Participant or Parent/Guardian for those under 18
Blind Sports Organization
465 Maplewood Road
Springfield, PA 19064-2901
(302) 836-5784 * www.blindsports.org
MEDICAL FORM
This form is to be completed by all who participate in BSO sponsored activities. It is for general informational purposes, which could be shared with emergency medical professionals.
Name: _______________________________________ Date of Birth: ____________________
Address: _____________________________City: _____________State: ______ Zip: _______
Phone: _________________________ E-Mail: ______________________________________
Health Insurance Company: _______________________ Policy Number: _________________
Emergency Contact: ___________________________________ Phone: __________________
Emergency Contact: ___________________________________ Phone: __________________
Primary Care Physician: ________________________________ Phone: __________________
Visual Diagnosis: ____________________________________ Visual Field: ______________
Best Corrected Acuity: Left Eye/OS - _______________ Right Eye/OD - _________________
Note: You may participate in our activities if you are 20/70 with best correction. However, to participate in National & International Competition, you must be “legally blind” (20/200 – totally blind).
*Dietary Request – If you have marked the registration form and have any reason to make a special dietary request, (diabetic, religious, allergies, other), please specify the type(s) of food(s) you need to avoid: ____________________________________________________________
Brief Medical History
Please circle if any of the following apply.
Allergies Diabetes Heart Disease Hypertension/High Blood Pressure
Retinal Issues Seizures Lung Disease/Asthma Low Blood Pressure
Surgeries Other: ___________________________
If you circled any of the above, please explain (i.e. list all allergies, treatments, medications, etc.): ________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________
Please advise us immediately of any changes. Thank you!
Signature: ___________________________________________ Date: ____________________
Participant or Parent/Guardian for those under 18
Note: For those under 18 who have seizures that are not currently controlled by medication, a parent or guardian should be present during activities.
Howard Johnson Inn & Suites and Conference Center
1119 South College Avenue
Newark, Delaware 19713
Phone: 302-368-8521
Toll Free: 888-268-8521
Fax: 302-368-9868
www.hojonewark.com
We are very happy that your group will be staying with us during their upcoming trip to Delaware! At the Howard Johnson Inn & Suites and Conference Center, we give you the satisfaction of knowing that your group will receive the most comfortable stay and friendly service at the best rates in town!
The rates (excluding tax) for the Goalball Championships are:
*King Standard Room (1 King bed) – $59.99
*Queen Standard Room (2 Queen beds) – $59.99
**King Studio Suite (1 King bed and sleeper sofa) – $69.99
**Double Studio Suite (2 Double beds and sleeper sofa) – $69.99
*The rates quoted are for 2 guests per room. **The rates for studios are for 3 guests per room. Additional guests over the age of 18 will be $10 per room per night.
Guests should call the Front Desk to make reservations under the group name “Goalball Championships”. We are holding 70 rooms for your group Friday, June 4 and Saturday, June 5, as well as 48 rooms on Sunday, June 6. These rooms will be held until 5/14/10. After this date, the room block will be released and regular room rates will apply based on availability. Please make sure any individual cancellations are made at least 48 hours prior to arrival. After this time frame, a one night no-show charge will apply per hotel policy.
The Howard Johnson Inn & Suites and Conference Center completed full renovations in 2009 including many upgrades. All standard rooms and suites are over-sized (25% larger than standard hotels) and new from the floor up! All accommodations include a refrigerator, microwave, and coffee maker. Enjoy free high-speed wireless Internet in all guest rooms and suites as well as public areas of the hotel. Forgot your computer? We also have a Business Center located in our Front Lobby open to all guests of the hotel. On-site, you will also find a seasonal outdoor pool, fitness center, and convenient laundry facilities.
A complimentary Deluxe Continental breakfast with hot Belgian waffles is included in all rates! Our newly renovated Breakfast Room is an enclosed room and seats up to 60 people. You can even watch the morning news in the Breakfast Room on our new 40” Plasma screen television! For quick snacks later in the day, stop by our new Hojo Market located in the Front Lobby where you will find an assortment of food and beverages 24 hours a day.
Our property is located in Newark, Delaware, at I-95 (DE Exit 1) & Rt. 896, less than a mile from the University of Delaware. We are 25 minutes from downtown Wilmington, DE, and we offer free parking.
TRANSPORTATION
Train
SEPTA – www.septa.org, (215) 580-7800
Regional Rail – R1 – PHL Airport to/from Center City Philadelphia
Regional Rail - R2 - Newark to/from Center City Philadelphia
Note: there are no trains from Newark on Sundays
AMTRAK – www.amtrak.com
The closest station is Wilmington, DE.
DART Busses run from the Amtrak station to the Univ. of Delaware campus.
Check www.DartFirstState.com or call (800) 652-3278 for info. about
local bus service.
Plane
Philadelphia International Airport (PHL)
This is located less than an hour drive from the hotel.
*If you plan to use public transportation to get to Newark, plan to arrive in PHL
no later than 1pm. Please see the train info. above.
Baltimore-Washington International Airport (BWI)
This is located just over an hour drive from the hotel.
From BWI, you could use Amtrak (see above).
Airport Shuttle Service - Delaware Express – www.delexpress.com or (302) 454-7800 serves BWI & PHL. Discount available if you book on-line.
1. Click on this link: www.delexpress.com
2. Click on “Online reservations and Quotes” in the box at the right side of the page
3. On the next page, do not click on anything. Scroll down to the bottom of page.
4. You will see the Frequent User Login box. Type in the word “Single” for one passenger for a 5% discount or “Express” for two or more passengers for a 25% discount.
5. Click the “Go” button next to the box.
6. This will take you to the Discount Portal page where you can start making your reservations.
7. Please have your credit card handy.
8. If you have any questions or concerns, please call (302) 454-7800.
Bus – Greyhound – www.greyhound.com
The closest station is Wilmington and it is located across the street from the train station.
*For additional information, please call Heidi or Sandy (302) 836-5784 or e-mail info@blindsports.org.*
Driving Directions
Automobile
To Howard Johnson Inn
- I-95 to Exit 1B (Newark Rt. 896 North)
- HoJos will be on your right within 0.1 mi.
To UD’s Carpenter Sports Building
- I-95 to Exit 1B (Newark Rt. 896 North)
- pass HoJos
- although 896 turns, stay straight going northbound on S. College Ave. to the end where you
must turn left (2 lanes turn left – be in the right lane)
- Left on E. Main
- quick Right on N. College Ave.
- Right at 1st driveway (if you get to train tracks, you’ve gone too far) and follow it around
until you see Carpenter Sports Bldg. Parking is all around that area. Note: you may see
signs on UD’s campus indicating Permit Parking Only. You may ignore them during
Nationals as the Campus Police will not be enforcing them (ticketing).
