register my child

Player Registration

Please Read: This form is the general contact form to enroll your child into programs. Once we receive the contact information you will be contacted to tour the Dream Center and fill out additional paperwork so that we may be better able to serve your child. Currently we have a waiting list for our students. Your child will be put on the waiting list after you complete this documentation. Once there is room for your child to join, you will be contacted by the Dream Center to set up a parent meeting and introduce you to programs. Thank you!

Mother/Guardian: *

First

Last

Father/Guardian: *

First

Last

* Indicates required field

Child *

First

Last

Gender *

Birthday *

School *

Home Phone *

Cell Phone *

Work Phone *

Email *

High School District *

Senior High School Hempstead High School Wahlert High School

How did you hear about the Dream Center? *

School Friend Social Media/Website

Other (please list) *

We do currently have a wait list for activities, by rating activity choices it allows us to get your child enrolled where and when we have openings.

Boys Activity Choices:

Girls Activity Choices:

First Activity Choice *

Second Activity Choice *

Third Activity Choice *

The information collected in this form is for administrative use, allowing us to provide the proper support and resources to your child.

Does your child receive free or reduced lunch? *

Yes No

I would like to be a part of the parent committee. *

Yes No

I give permission for my child to be photographed, interviewed, or recorded on audio or videotape. I understand these images or recordings may be edited, copied, exhibited, published, or distributed for program promotion, fundraising purposes and other diverse ways within an unrestricted area. Photographic, audio or video recordings may be used for the following purposes: • Workplace presentations • Educational presentations or meetings • Informational presentations or meetings • Website content • Social media • Emails • Brochures, flyers or other agency printed materials for distribution By signing this release, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in public settings. *

Yes No

Medical Release History

Health Statement: (to be completed by Parent/Guardian and/or Medical Doctor). YES responses will require an explanation. If there are any changes to your child's medical needs please email rmcclellan@dbqdream.org with updated information.

Respiratory problems – Asthma, persistent cough, etc. *

yes no

Heart problems – High/low blood pressure, chest pain, etc. *

yes no

Kidney, stomach, Gall Bladder or Liver problems *

yes no

Diabetes, hypoglycemia *

yes no

Recent fractures, illness, exposure to contagious disease, etc. *

yes no

Choose OneEye, ear, nose or throat problems – Skin disease *

yes no

Allergies – Bee stings, ant bites, plants, sun, food, penicillin, etc *

yes no

Emotional disorders – Frequent anxiety, excessive fears, etc. *

yes no

Any hospitalization in the last two years? *

yes no

Does your child have any physically limiting conditions? *

yes no

Does your child currently take medication? *

yes no

The participant WILL be bringing medication to programs and activities *

yes no

If you answered yes to any of the above questions please explain: *

Emergency Medical Treatment: I understand that every effort will be made to contact the parent(s) or guardian (s) of participants. If this is not possible, I hereby Authorize the Dubuque Dream Center to obtain medical treatment.

Parent/Guardian Signature *

First

Last

Father has authorization to remove child *

yes no

If Not please explain: *

Mother has authorization to remove child *

yes no

If Not please explain: *

My child can be transported to and from school, Dream Center, home, and tournaments by a Dream Center staff member *

Yes No

Comments regarding transportation and pick-up authorization *

Other has authorization to remove child *

First

Last

Phone Number *

Other has authorization to remove child *

First

Last

Phone Number *

Comment *

Conflict Resolution

Heath & Nutrition:
Basketball Players must be excellent athletes. Stretching before practices, games, etc. is mandatory. Players must demonstrate the coordination, athleticism, and flexibility, which is necessary in basketball.
An injury must be reported to the coach immediately. The coach must approve an absence from practice, game, etc. due to a player attending an appointment with a personal physician, in advance. If an injury or illness incapacitates a player, they will not be permitted to practice or play for a period of time as determined by their physician and the coach.
Good nutritional habits are encouraged throughout the season. Coaches should provide encouragement and guidance.

Player Attendance Policy.
*Coaches are to be notified in advance of any absences or if participant is to be late

Conflict Resolution:
Parents – Please respect the coaches for their decisions. A coachs’ decision is not questionable.  Please don’t coach your child from the sideline during the game. If you have an issue, speak to the coach at an appropriate time.
Player issues are to be directed to the head coach of a team. They are to be resolved at a non-game situation (i.e. before or after practice if coach approves, separate scheduled meeting, etc). Players are encouraged to speak with the coach themselves, then, if necessary, the parents should contact the coach. If resolution cannot be attained in this manner, a meeting with all necessary parties may be called if deemed necessary.
Remember: Coaches and parents are facilitators in making this a productive and enjoyable experience. All of the above Procedures, Policies, and guidelines are subject to revisions or changes.
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I have read, understand, and agree to comply with the Dubuque Dream Center Intensity Policies (see below submit button) and Procedures as stated. I understand that my child will be put on the waiting list for programs, and I will be contacted by the Dream Center once there is an opening.

I give my child permission to participate in the Dubuque Dream Center Intensity and other programs. My child can be transported by Dream Center to school, home, Dream Center, or tournaments when applicable. I also give permission for my child to be photographed or recorded for program promotion and fundraising purposes. With that acceptance, I agree to abide by the rules and obligations stated in the Policy and Parent Pledge. My signature below means that I agree to the above.

Intensity Parent Signature *

First

Last

Intensity Player Signature *

First

Last

Dream Center Basketball Policies
File Size:	325 kb
File Type:	pdf

Dream Center Volleyball Policies
File Size:	192 kb
File Type:	pdf

Player Registration

Boys Activity Choices:

Girls Activity Choices:

Medical Release History

Conflict Resolution

Location

The Dubuque Dream Center

Connect
With Us

Player Registration

Boys Activity Choices:

Girls Activity Choices:

Medical Release History

Conflict Resolution

Location

The Dubuque Dream Center

Connect With Us

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With Us