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 *

Parent/Guardian Name (for Unified Partners under the age of 18 and ALL athletes)

Parent/Guardian/StaffAddress

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Parent/Guardian/Staff Phone Number

Area Code Phone Number

Parent/Guardian/Staff Cell Phone

Area Code Phone Number

Individual Sport Athletes and Unified Partners

You will need to fill out and submit all of the above information for athlete/Unified Partner. You must have or will receive a gold medal at state competition in the sport for which you are applying in, starting with Summer Games competition year 2018 and finishing with 2021 Summer Games.

Parent/Guardian/Staff E-mail

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

Team name (be specific, ie: Springfield Blue Falcons)

Basketball-Unified

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

3-3 Basketball-Unified

Athlete-Female Unified Partner-Female (no more than 5)

3-3 Basketball

Athlete-Female

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. *