Please select one: *

Are you a new athlete or re-registering?

New athlete

Returning athlete

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Language(s) Spoken in Athlete's Home *

English

Spanish

Other:

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Does the athlete have the capacity to consent to medical treatment on his or her own behalf? *

Yes

No

Is the athlete a minor or does the athlete have a legal guardian? *

Yes

No

Guardian Address (if different)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian Phone

(###)

###

####

Physician Name *

First Name

Last Name

Physician Phone *

(###)

###

####

ATHLETE LIKENESS RELEASE FOR SPONSORS *

Special Olympics relies on sponsors and partners to help support our mission. We often use photos, videos and stories of our athletes to show the impact of support by companies that sponsor Special Olympics. If you wish to allow your likeness to be used in this way, please read and sign below. I agree to the following: 1. I give permission to Special Olympics, Inc., Special Olympics games organizing committees, and Special Olympics accredited Programs (collectively “Special Olympics”) and their sponsors and partners to use my likeness, photo, video, name, voice, and words (“my likeness”) to acknowledge the sponsors’ and partners’ support for Special Olympics. 2. Special Olympics and its sponsors and partners will not use my Likeness to endorse commercial products or services. 3. I understand I will not be compensated for the use of my Likeness.

I agree to allow my image to be used

I decline

Liability *

By checking this box I agree that I have read and understand this form. If I have questions, I will ask. By signing, I agree to this form. If I am a parent or guardian of the athlete, I agree that I have read and understand this form and have explained the contents to the athlete as appropriate. By signing, I agree to this form on my own behalf and on behalf of the athlete.

Release and Waiver *

By checking this box I agree that I have read and understand the athlete release and Covid-19 release. If I am a parent or guardian of the athlete, I agree that I have read and understand the athlete release and Covid-19 release and have explained the contents to the athlete as appropriate. By signing, I agree to the release and waiver.

Today's Date

MM

DD

YYYY