Athlete Intake Form

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Password must contain the following:
  • 12 Characters
  • 1 Uppercase letter
  • 1 Lowercase letter
  • 1 Number
  • 1 Special character



Athlete Information



















Parent/Guardian Information











Emergency Contact Information




Additional Contacts

Please provide their information below. This person will receive copies of official
communications on your behalf.





Associated Conditions


Assistive Devices and Accommodations
Do you use any of the following? Check all that apply:








General Health Questions
Yes No

Yes No


Yes No

Yes No


Medications

Please list any medications, vitamins, or dietary supplements below:







Athlete Release
WAIVERS, RELEASES, AND POLICIES
Please read the following information fully before signing.

I agree to the following:

1. Ability to Participate. I am physically able to take part in Special Olympics activities, and will abide by all applicable rules, requirements and codes of conduct.

2. Likeness Release. I give permission to Special Olympics, Inc., Special Olympics games organizing committees, Special Olympics accredited Programs (collectively “Special Olympics”), as well as official Special Olympics supporters and partners that have authorization from Special Olympics, to use my likeness, photo, video, name, voice, words, biographical information and similar or related material (my “likeness”) to promote Special Olympics and raise funds for Special Olympics. I understand that my likeness may be used in all forms of media in local or global campaigns – including those by supporters and partners of Special Olympics – but understand that my likeness will not be used to endorse commercial products or services. I understand that I will not be compensated for the use of my likeness.




I am the parent/guardian of the athlete and agree to the following:

1. No Consent to Emergency Medical Care. I understand that Special Olympics’ standard registration form requires athletes or their parents or guardians to consent to emergency medical care for the athlete if needed in an emergency.
Based on religious beliefs or other reasons I am not consenting to emergency medical care as follows.

2. Accompaniment of Athlete. I understand that I must be present in order to take personal responsibility for the athlete if any medical treatment is to be refused on the athlete’s behalf in a medical emergency arises. This includes
during meal times, in overnight accommodations, at training sessions and competitions, and during travel to and from Special Olympics activities.

3. Emergency Medical Care If Athlete Is Not Accompanied. I understand that, if I am not present and actively taking personal responsibility for the athlete during a medical emergency, Special Olympics may seek emergency medical
care for the athlete as recommended by medical professionals responding to the emergency.

4. Liability Release. On behalf of myself and the athlete, I release Special Olympics, its employees, and its volunteers from all claims that may arise out of taking or failing to take measures to provide the athlete with emergency medical
care. I am agreeing to this release because I have refused, knowingly and voluntarily, to give Special Olympics permission to take emergency measures, and I am expressly withholding consent to emergency medical care on religious or other grounds. For this form, “Special Olympics” means all Special Olympics organizations.
I am a Special Olympics athlete with capacity to sign documents on my own behalf and agree to the following:

1. No Consent to Emergency Medical Care. I understand that Special Olympics’ standard registration form requires athletes or their parents or guardians to consent to emergency medical care for the athlete if needed in an emergency.
Based on religious beliefs or other reasons I am not consenting to emergency medical care.


2. Printed Instructions. I agree to carry printed instructions that describe my religious or other objections to medical treatment and how I wish the person accompanying me to respond if I get sick or hurt and cannot speak for myself. I
agree to carry these printed instructions with me at all times during my  participation in any Special Olympics activity, including during meal times, in overnight accommodations, at training sessions and competitions, and during travel to and from Special Olympics activities.

3. Friend or Family Accompaniment. I understand that I must be accompanied by an adult friend or family member in order for that person can take personal responsibility for me during a medical emergency where I am unable to speak for myself.

4. Emergency Medical Care. If Athlete Is Not Accompanied. I understand that, if I am not carrying the printed instructions or the accompanying adult is not present and actively taking personal responsibility for me during a medical emergency where I am unable to speak for myself, Special Olympics may seek emergency medical care for me as recommended by medical professionals responding to the emergency.

5. Liability Release. I release Special Olympics, its employees, and its volunteers from all claims that may arise out of taking or failing to take measures to provide me with emergency medical care. I am agreeing to this release because I have refused, knowingly and voluntarily, to give Special Olympics permission to take emergency measures, and I am expressly withholding consent to emergency medical care on religious or other grounds. For this form, “Special Olympics” means all Special Olympics organizations.
4. Overnight Stay. For some events, overnight accommodations may be required. If I have questions, I will contact my Special Olympics Program.

5. Health Programs. If I take part in a health program, I consent to health activities, screenings, and treatment. This should not replace regular health care. I have the right to decline Health programming treatment (which is different from sideline or emergency medical care) at any time.”

6. Personal Information. I understand that Special Olympics will be collecting my personal information as part of my participation,
including my name, image, address, telephone number, health information, and other personally identifying and health related
information I provide to Special Olympics (“personal information”).

I agree and consent to Special Olympics: 
  • Using my personal information in order to: make sure I am eligible and can participate safely; run trainings and events; share competition results (including on the Web and in news media); provide health treatment if I participate in a health program; analyze data for the purposes of improving programming and identifying and responding to the needs of Special Olympics participants; perform computer operations, quality assurance, testing, and other related activities; and provide event-related services. 
  • Using my contact information for communicating with me about Special Olympics. 
  • Sharing my personal information confidentially with (i) researchers such as universities and public health agencies that are studying intellectual disabilities and the impact of Special Olympics activities, (ii) medical professionals in an emergency, and (iii) government authorities for the purpose of assisting me with any visas required for international travel to Special Olympics events and for any other purpose necessary to protect public safety, respond to government requests, and report information as required by law. 
  • I have the right to ask to see my personal information or to be informed about the personal information that is processed about me. I have the right to ask to correct and delete my personal information, and to restrict the processing of my personal information if it is inconsistent with this consent. 
Privacy Policy. Personal information may be used and shared consistent with this form and as further explained in the Special Olympics privacy policy at www.SpecialOlympics.org/Privacy-Policy. 

SYMPTOMS FOR SPINAL CORD COMPRESSION and ATLANTOAXIAL INSTABILITY
(For athlete with Down syndrome only)
If I (or the athlete) have been diagnosed with or experienced any of the following symptoms that have increased in severity over the past three years – difficulty controlling bowels or bladder; numbness or tingling in legs, arms, hands, or feet; weakness in arms, legs, hands or feet; burner/stinger/pinches nerve, pain in neck, back shoulders, arms, hands, buttocks, legs or feet; spasticity or paralysis – I must obtain a review and permission from a licensed medical practitioner to train and/or participate in Special Olympics activities.

WAIVER AND RELEASE OF LIABILITY / ASSUMPTION OF RISK / INDEMNIFICATION
In consideration of being allowed to participate in any way in Special Olympics activities, the undersigned acknowledges, appreciates,
and agrees that:

1. While particular rules and personal discipline may reduce this risk, the risk of illness (including communicable diseases), injury (including concussion), disability, and death does exist;

2. If I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest Special Olympics representative immediately; and,

3. I understand the risks involved with participation in Special Olympics activities. I fully accept and assume all risks and all responsibility for losses, costs, and damages I may incur as a result of my participation. To the fullest extent of the law, I release and agree not to sue any Special Olympics organization, its directors, agents, volunteers, and employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable owners and lessors of premises on which any Special Olympics activity is occurring (“Releasees”) related to any liabilities, claims, or losses on my account caused or alleged to be caused in whole or in part by the Releasees even if arising from the negligence of the Releasees. I have read this release of liability and assumption of risk provision, fully understand its terms, acknowledge that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement. I further agree that if, despite this release, I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify and hold harmless each of the Releasees from any such liabilities, claims, or losses as the result of such claim. I agree that if any part of this form is held to be invalid, the other parts shall continue in full force and effect.

Select the button below to sign your form. Once signed, select the link in your email to finalize your signature.

Hidden Fields


Save my progress and resume later | Resume a previously saved form

Contact Information