Young Athletes Registration Form

Parent/Guardian Information

First Name

Last Name

I prefer communication in:

EnglishSpanish

Email Address

Phone Number

Mailing Address (House #, Street, Apt #)

City

State

Zip Code

County Name:

County in which you reside in

How did you hear about the Young Athletes Program?

Name of School:

Name of Service:

If Other, use space below:

Athlete Release Form:

I am the parent or guardian of the Young Athlete named above and agree to the following:

1. Able to Participate. The Young Athlete is able to take part in Special Olympics. I understand there is a risk of injury.

2. Photo Release. Special Olympics organizations may use the Young Athlete’s picture, video, name, voice and words to promote Special Olympics.

3. Emergency Care: If a medical emergency should arise during the Young Athlete’s participation in Special Olympics activities at a time when a parent or guardian is not present to make medical decisions, I consent to medical care for the Young Athlete if needed, unless I check one of these boxes:

I have a religious or other objection to the Young Athlete receiving medical treatment.

I consent to emergency medical care, but I do not consent to blood transfusion for the Young Athlete.

(If either box is checked, an EMERGENCY MEDICAL CARE REFUSAL form will be sent and MUST be completed)

4. Health Programs. If the Young Athlete takes part in a Special Olympics health program, I consent to health activities, exams and treatment for the Young Athlete. This should not replace regular health care. I can say no to treatment or anything else at any time for the Young Athlete.

5. Personal Information. I understand personal information may be used and shared by Special Olympics to:

Make sure Young Athletes can participate safely;
Run training and events and share results;
Put the Young Athletes information in a computer system;
Provide health treatment, make referrals, consult doctors, and remind me about follow-up services;
Research, share and respond to needs of the Special Olympics participants (identifying information removed if shared publicly); and
Protect health and safety, respond to government requests, and report information required by law.
I can ask to see and change the Young Athlete’s information. I can ask to limit how the information is used.

6. Concussions. I understand there is a risk of concussions and continuing to play sports with a concussion. The Young Athlete may have to get medical care if a concussion is suspected. The Young Athlete may also have to wait 7 days or more and get permission from a doctor before he/she starts playing sports again.

I am the parent/guardian of the participant named on this registration form. I have read and fully understand the provisions of the above release. Through my signature on this release form, I am agreeing to the above provisions on my own behalf and on the behalf of the participant named above to participate in Special Olympics games, recreation programs and physical activity programs.

Parent/Guardian Signature

Date

Emergency Care Refusal Form

PARENT/GUARDIAN COMPLETION

(To be completed by parent or guardian of athlete who is under 18 years old or otherwise has a legal guardian)

Instructions: Only complete this form if you do not consent to emergency medical care on religious or other grounds and have checked a box under the Emergency Care provision on the Athlete Release Form or Young Athletes Individual Registration Form.

I am the Parent/Guardian of:

Enter your young athlete's full name in space provided above.

As the parent/guardian of said athlete or young athlete, to be referred to as the Athlete in the rest of this form, I 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.

YOU MUST CHECK THE BOX AND WRITE YOUR INITIALS FOR ONE STATEMENT TO CONFIRM YOUR INTENT:

I DO NOT CONSENT TO ANY KIND OF MEDICAL TREATMENT, EVEN IN A LIFE-THREATENING EMERGENCY. (Checkbox 1)I DO NOT CONSENT TO BLOOD TRANSFUSIONS, EVEN IN A LIFE-THREATENING EMERGENCY. I CONSENT TO ALL OTHER KINDS OF MEDICAL CARE. (Checkbox 2)

Initial for Checkbox 1

Initial for Checkbox 2

2. Accompaniment of Athlete. I agree to be present with the Athlete at all times during any Special Olympics activity, so that I can be readily available to take personal responsibility for the Athlete if 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. I understand that if I am not present at all times, the Athlete will not be permitted to participate in Special Olympics activities, and that no exceptions will be made.

3. No Guarantee. I understand that Special Olympics cannot guarantee that emergency medical care will be withheld if I am not present and actively taking personal responsibility for the Athlete during a medical 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 directing Special Olympics not to do so on religious or other grounds.

By signing, I agree to accompany my young athlete during Special Olympics activities and take personal responsibility for my child during an emergency. I understand the extent to which the athlete does not consent to emergency medical care and I agree to act in accordance with the athlete wishes as I understand on their behalf.

Parent/Guardian Full Name:

Parent/Guardian Initials Here:

Relationship to Participant:

Today's Date:

WAIVER AND REALEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEGEMENT FOR COMMUNICABLE DISASES
("Agreement") for
SPECIAL OLYMPICS NEW JERSEY

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 FROMTHE 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 ANDHOLD HARMLESS Special Olympics, Inc, Special Olympics New Jersey, 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 OFRELEASEES OR OTHERWISE, to the fullest extent permitted by law.

Signature Type

Parent/ Guardian Signature (Required for participant who is a minor (younger than age 18) or lacks capacity to sign documents.)

Parent/Guardian Signature

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 indemnify and hold harmless the Releases 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.

Parent/Guardian Signature

(By signing this Communicable Diseases Waiver electronically, you agree your electronic signature is the legal equivalent of your manual signature.)

Date:

Relationship to participant

American Indian/Alaskan Native	Black or African American
White or Caucasian	Asian American
Native Hawaiian or Other Pacific Islander	Hispanic or Latinx