Young Athletes Application

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.