Young Athletes Application Step 1 of 4 25% This application registers your child with Special Olympics Minnesota. You will still need to register your child directly with the program you'd like to join. Visit our Young Athletes page for contact information.Brooklyn Center Young Athletes – Session 1Brooklyn Center Young Athletes – Session 2Grand Rapids Young AthletesHutchinson Young Athletes – Session 1Hutchinson Young Athletes – Session 2Macalester Young AthletesRochester Young AthletesSouthdale Edina Young Athletes – Session 1Southdale Edina Young Athletes – Session 2Woodbury Young Athletes Athlete InfoAthlete's registration*Traditional Young Athlete (diagnosed with intellectual disability)Peer partner (not diagnosed with intellectual disability)What is the athlete's diagnosis? (optional)Athlete's name* First Last Athlete's gender*FemaleMaleOtherAthlete's birthdate* Date Format: MM slash DD slash YYYY Athlete's T-shirt size*Athlete's address* Street Address City State / Province / Region ZIP / Postal Code Athlete's schoolPlease check the applicable options. My child attends a formal daycare or preschool program. My child attends school. My child is in grade/year: Parent/Guardian InfoGuardian's name* First Last Guardian's home phone number*Guardian's work phone number (optional)Guardian's email address* Emergency Contact Infoother than parent/guardianEmergency contact's name* First Last Emergency contact's phone number* Health HistoryPlease check the items that apply to your child. Allergies Asthma Blindness/visual problems (besides corrective lenses) Bone or joint problem Chest pain Concussion or serious head injury Glasses/contact lenses Diabetes Easy bleeding Emotional/psychiatric/behavioral problems Hearing loss/hearing aid Heart disease/heart defect/high blood pressure Heat stroke/exhaustion Immunizations up to date Major surgery or serious illness Non verbal Seizures/epilepsy/fainting spells Sensory issues (please list in Notes) Sickle cell trait or disease Special diet Tobacco use in household Uses wheelchair or other walking assistive device What behavior management strategies are used at home?Does your child have any special dietary concerns? (optional)Notes or comments (optional)WaiverConsent* I accept the terms of this waiver.I am the parent/guardian of the child (Athlete) on whose behalf I have submitted this Application for Participation in Young Athletes. I hereby represent that the Athlete has my permission to participate in Young Athletes activities. I further represent and warrant that to the best of my knowledge and belief, the Athlete is physically and mentally able to participate in Special Olympics activities. In permitting the Athlete to participate, I am specifically granting my permission, (both during and anytime after), to Special Olympics to use the Athlete's likeness, name, voice and words in television, radio, film, newspapers, magazines and other media, and in any form, for the purpose of advertising or communicating the purposes and activities of Special Olympics and/or applying for funds to support those purposes and activities. If a medical emergency should arise during the Athlete's participation in any Special Olympics activities, at a time when I am not personally present so as to be personally consulted regarding the Athlete's care, I hereby authorize Special Olympics, on my behalf, to take whatever measures are necessary to ensure that the Athlete is provided with any emergency medical treatment, which Special Olympics deems advisable in order to protect the Athlete's health and well-being. I am the parent/guardian of the Athlete named in this application. I have read and fully understand the provisions of the above consent, and have explained these provisions to the Athlete. Through my signature on this consent form, I am agreeing to the above provisions on my own behalf and on the behalf of the Athlete named above. I hereby grant my permission for the above named Athlete to participate in Special Olympics games, recreation programs and physical activity programs.