Young Athletes At-Home Activity Tracker Program
Young Athlete Registration
Area/County:
Please select...
Area 1: (Hudson)
Area 2: (Passaic)
Area 3: (Sussex, Warren, Morris)
Area 4: (Hunterdon)
Area 5: (Union, Middlesex)
Area 6: (Ocean, Monmouth)
Area 7: (Camden, Gloucester, Salem)
Area 8: (Atlantic, Cape May, Cumberland)
Area 9: (Essex)
Area 10: (Somerset)
Area 11: (Mercer)
Area 12: (Bergen)
Area 13: (Burlington)
First Name
Last Name
Birthdate (mm/dd/yyyy)
Gender:
Female
Male
Registrant Type
Young Athlete: Child age 2-7 with a disability
Unified Partner: Child age 2-7 without a disability
Does this Athlete have?
(check all that apply)
Autism
Cerebral Palsy
Down Syndrome
Fetal Alcohol Syndrome
Fragile X Syndrome
Unidentified
Other:
Please mark items you would like Special Olympics to know:
Requires wheelchair accessibility
Medical condition
Special Diet/Allergies
Other:
Parent/Guardian Information
Parent First Name
Parent Last Name
Email Address
Phone Number
Home Kit Request
As we process your home kit request, please confirm below your home address. Allow 2 weeks from requested date to be delivered to your home.
Mailing Address (House #, Street, Apt #)
City
State
Zip-Code:
Pre-Program Survey
Share with us how you hope this program will benefit you and your Young Athlete while engaging at home and participating in our 8-week At-Home Activity Tracker Program.
What skills or activities do you want to see your child improve on?
(Select all that apply)
Social interaction
Listening skills
Building a routine and structure
Shape and color recognition
Body awareness
Strength & Flexibility
Throwing & Catching
Kicking & Striking
Balance & Jumping
Walking & Running
What other skills and areas would like to see your athlete improve on while participating?
What Young Athletes resources will you be using to implement this program at home?
(Select all that apply)
Online videos and resources supported by SONJ
Young Athletes Activity Guide
Young Athletes Flashcards
Home Kit
Household items
All materials and resources will be provided digitally and will be sent to your email to download.
By participating in this program what do you and Young Athlete hope to achieve?
Can you and your Young Athlete commit to a full 8-weeks?
Yes
No