Young Athletes Application - Special Olympics Minnesota

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We will send you an email with more details prior to your first session. If there are no current programs near you, you will receive follow-up information from a SOMN staff member.

Select event

Child's info

Child's registration*

Traditional Young Athlete (diagnosed with intellectual disability)

Peer partner (not diagnosed with intellectual disability)

Child's name*

First Last

Child's gender*

Child's birthdate*

MM slash DD slash YYYY

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What is the athlete's diagnosis? (optional)

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Child's T-shirt size

Child's address*

Street address City State ZIP code

Child's t-shirt size*

Child's school

Please check all that apply.

My child attends a formal daycare or preschool program.

My child attends school.

My child is in grade/year: (optional)

Which of the following best describes your child? (optional)

Please check all that apply.

Asian or Pacific Islander

Black or African American

Hispanic or Latino

Native American or Alaskan Native

White or Caucasian

Multiracial or Biracial

A race/ethnicity not listed here

Please describe your child's race/ethnicity. (optional)

Parent/guardian info

Guardian's name*

First Last

Guardian's cell phone number*

Guardian's work phone number (optional)

Guardian's email address*

Emergency contact info

Please enter contact information for someone other than the child's parent or guardian.

Emergency contact's name*

First Last

Emergency contact's cell phone number*

Health history

Please check the items that apply to your child.

Health diagnoses

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? (optional)

Does your child have any special dietary concerns? (optional)

Notes or comments (optional)

Communicable Disease Waiver

Please scroll through the text in the box below and ensure that you understand the waiver points before signing.*

I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.

WAIVER AND RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT FOR COMMUNICABLE DISEASES (“Agreement”) for SPECIAL OLYMPICS

In consideration of being allowed to participate in any way in Special Olympics sports training, competition or fundraising activities, the undersigned acknowledges, appreciates, and agrees that:

1. Participation includes possible exposure to and illness from infectious and/or communicable diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and 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 official immediately; and,

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Special Olympics, Inc, Special Olympics Minnesota their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

For participants of minority age (under age 18 at the time of registration) or athletes who are not their own guardian*

I agree to the parent/guardian waiver.

This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.

Program Waiver

Consent*

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.