Poly Hockey TEQ 2023
In order to make team registration easier at the event, we ask that you fill out ONE of these forms PER TEAM. Please note that we ask for the number of coaches and chaperones so they can receive the appropriate meal tickets and wristbands. This form should be completed and turned in with your registration materials. Thank you for your assistance.
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Email *
Area/School *
If you are registering a Unified Champion School please and do not know your area number please select "other"
Team Name *
2023 Team Name *
If you did not have a team in 2023 write N/A
Please Select Team Type *
Note: Co-ed teams will play in the Male division
Please Select Event type *
Are you attending 2023 Poly Hockey, Flag Football and Unified Bowling Event? *
Head Coach Name (First, Last) *
Phone Number *
Email Address *
Years of Special Olympics coaching experience *
Years coaching this team *
Assistant Coach Name (First, Last)
Assistant Coach Email Address
Please list any additional emails that would like to get communications regarding this team
Are the majority of this year's players the same as last year? *
Required
List any significant changes in your team this year: *
Based on a 10-division tournament, in what division would you place this team this year? *
It is a state requirement that you turn in the results of three game scores by October 23rd. These games should be with other Special Olympics teams. If you have problems answering the above questions, please call the state office for further information. Please check if you acknowledge this requirement. *
Required
In an effort to help evaluate the ability level of your team, we ask that you provide the following information. Please honestly rate your team as a whole on the following poly hockey skills by selecting the appropriate number, with the number 1 being the lowest ability and 10 the highest. We then ask that you total your team's score and place at the bottom. Please check if you acknowledge this requirement. *
Required
USING THE DIRECTIONS FOR EACH SKILL, EVALUATE EACH ATHLETE INDIVIDUALLY FOR EACH OF THE 4 LISTED SKILLS.
TAKE THE THREE HIGHEST SCORES AND RECORD THEM BELOW
Event #1: Shoot around the goal (For event instructions please hover mouse over the image, or visit https://www.somi.org/sites/default/files/resources/POLY%20HOCKEY%20RULES.pdf
Athlete takes one shot from five different spots around the goal. These spots are located at the end points of five 6-meter rays, which start from a common point. Each ray is drawn such that it creates a 30 degree angle with the goal line or with a previously-drawn ray. An athlete has a 30 second time limit to shoot all the pucks. One puck shall be at each spot before the athlete starts. Scoring: Each puck that completely crosses the goal line into the goal is worth five points. The score is the total of the five shots with 25 points maximum.
TEAM SKILL SCORE OF:         0 - 15 = 1,     16 - 31 = 2,        32 - 47 = 3,      48 - 63 = 4, 64 - 75 = 5 *
Total Score:
Event #2 - Pass
Athlete makes five passes from behind a line. Athlete tries to pass the puck between two cones 4 feet apart that are placed 32 feet from the passing line. Each time the puck passes completely across the line between the two cones, the athlete shall be awarded five points. If the puck hits the cone, but still passes through the cones, the athlete shall be awarded three points. The athlete's total score is the sum of the five passes with 25 points maximum.
TEAM SKILL SCORE OF:         0 - 15 = 1,     16 - 31 = 2,        32 - 47 = 3,      48 - 63 = 4, 64 - 75 = 5 *
Total Score:
Event #3 - Stick Handling
Athlete stick handles the puck from a starting line through a course defined by cones and shoots the puck at the goal. The distance from the start line to goal line shall be 21 meters. The cones shall be placed in a straight line at intervals of 3 meters. The clock stops when the puck passes the goal line. Scoring: The time spent stick handling is subtracted from 60. If any cones are missed, one point is subtracted for each miss. Five bonus points are given if the athlete scores a goal.
TEAM SKILL SCORE OF: 0 - 36 =  1,  27 - 73 = 2,   74 - 110 = 3,    111 - 146 = 4, 147 - 180 = 5 *
Total Score:
Event #4 - Shoot For Accuracy
Athlete takes five shots from behind a line that is five meters from and directly in front of, the goal. Six sections are defined within the goal by rope or tape as shown in the diagram. The vertical rope or tape is hung 45 cm (18") in from each goal post. The horizontal rope or tape is strung 30 cm (12") above the floor. Scoring: The goal is divided into point sections as follows: -5 points for any shot entering the goal in either of the upper corners. -3 points for any shot entering the goal in either of the lower corners. -2 points for any shot entering the goal in the upper middle section. -1 point for any shot entering the goal in the lower middle section. -0 points for any shot not entering the goal
TEAM SKILL SCORE OF: 0 - 15 =  1,  16 - 31 = 2,   32 - 47 = 3,      48 - 63 = 4, 64 - 75 = 5 *
Total Score:
TEAMS’ GENERAL POLY HOCKEY KNOWLEDGE     *
FINAL SCORE
Add the total score from each of the 4 events, plus the rating for the teams general knowledge. Maximum score of 30
Please write below any pertinent comments that may not be covered above that would help evaluate the overall team ability.
A copy of your responses will be emailed to the address you provided.
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