USA Games Athlete/Unified Partner Registration Form

USA Games Athlete/Unified Partner Registration Form
Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Gender *

Male Female
Date of Birth (MM/DD/YYYY) *
Phone Number *

- Area Code Phone Number
Shirt Size
Cell Phone *

- Area Code Phone Number
E-mail *
Email
example@example.com
Email
example@example.com
Parent/Guardian Name (for Unified Partners under the age of 18 and ALL athletes)

Parent/Guardian Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent/Guardian Phone Number

- Area Code Phone Number
Parent/Guardian Cell Phone

- Area Code Phone Number
Parent/Guardian E-mail
Athlete/Unified Partner can be nominated in TWO sports, but will only be selected in ONE sport to attend Selection Camp in June 2017 (athletes and Unified Partners must receive a gold medal at state competition in the sports for which they apply)
Track & Field

Athlete- Male Athlete-Female
Swimming

Athlete-Male Athlete-Female
Bocce

Athlete-Male Athlete-Female Unified Partner-Male Unified Partner-Female
Bowling

Athlete-Male Athlete-Female Unified Partner-Male Unified Partner-Female
Golf

Athlete-Male Unified Partner-Male
Powerlifting

Athlete-Female Athlete-Male
Tennis

Athlete-Male Unified Partner-Male
Sport Teams must be nominated as an already-existing team (CANNOT be nominated as individual athletes). You will need to fill out and submit all of the above information for EVERY athlete/Unified Partner on your team (teams must receive a gold medal at state competition in the sport for which they apply).
Basketball-Unified

Athlete-Female Athlete-Male Unified Partner-Male (no more than 5) Unified Partner-Female (no more than 5)
Softball-Regulation

Athlete -Male Athlete-Female
Team name (be specific, ie: Springfield Blue Falcons)
Has this athlete/Unified Partner ever attended a USA Games? *

Yes No
If yes, what year?
How long has athlete/Unified Partner participated in Special Olympics Missouri? *
Other SOMO Sports Participated in *
Other Hobbies/Hidden Talent *
Who is your hero/idol and why? *
Where do you go to school (or work)? *
If you have a job, what kind of job do you do?
Have you been to a USA (National) Games before? If yes, what year/city and what sport? *
Favorite moment at a SOMO event: *
Why do you want to go to the USA Games? *
Name of your local coach for the sport for which you're applying *
Local Coach's Phone Number *

- Area Code Phone Number
Comments?
I have read and understand the job description and general expectations of the position and that the information I have given SOMO is true and complete. I understand I will need to attend all trainings, the selection camp and conference calls. I understand I will need to raise a minimum of $3,000 to cover my expenses. I understand the SOMO staff may remove me from the delegation if I fail to meet the requirement of the job description or act outside the Code of Conduct. Please type your first and last name below. *
Should be Empty:

USA Games Athlete/Unified Partner Registration Form

Athlete/Unified Partner can be nominated in TWO sports, but will only be selected in ONE sport to attend Selection Camp in June 2017 (athletes and Unified Partners must receive a gold medal at state competition in the sports for which they apply)