Special Olympics Kansas Class A Coach/Unified Partner Registration

Special Olympics Kansas Young Athlete Registration
All Young Athletes ages 2-7 with ID (Intellectual Disabilities) and without ID must be registered prior to participating within Special Olympics Kansas Young Athletes Programs and events.

Special Olympics Young Athletes™ is an inclusive early childhood sports and educational play program for children aged 2 to 7 years old, with and without intellectual disabilities, that includes games, songs and other fun, physical activities. With an emphasis on training and participation through activities and play, rather than competition, young athletes learn basic sports skills like kicking and throwing a ball, and playing with others. Young Athletes™ also provides children with gross motor skills training, group interaction and socialization opportunities. These basic skills will prepare the Young Athletes for future participation in sports.
Are you new to Special Olympics Kansas or re-registering?*

NewRe-Registering
Special Olympics Kansas Young Athletes Local Program (if known) or Elementary School
Date of Birth*

MonthDayYear
Young Athlete Full Name*

First NameLast Name
Gender*

MaleFemaleOther Gender IdentityNo Answer
Has an Intellectual or Developmental Disability:*

YesNo
Race/Ethnicity (Optional):

American Indian/Alaskan NativeAsianBlack or African AmericanHispanic or LatinxNative Hawaiian or Other Pacific IslanderWhite or CaucasianTwo or More RacesPrefer not to answer
Language(s) Spoken in Young Athlete's Home (Optional):

EnglishSpanishOther
Select All That Apply:

Requires Wheelchair Accessible LocationHas Language Assistance NeedsMedical ConditionsSpecial DietOther
Please expand on any special conditions or facility requirements that would need to be met to ensure a quality experience.
Parent/Guardian Information
Name*

First NameLast Name
Relationship to Young Athlete*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Consent and Sign

I agree to the following:
I am the Parent or Guardian of the Young Athletes participant named below and agree to the following:

1. Able to Participate. The Young Athlete is physically able to take part in Special Olympics.

2. Likeness Release. I give permission to Special Olympics, Inc., Special Olympics games organizing committees, and Special
Olympics accredited Programs (collectively “Special Olympics”) to use the Young Athlete’s likeness, photo, video, name,
voice, words, and biographical information to promote Special Olympics and raise funds for Special Olympics.

3. Risk of Concussion and Other Injury. I know there is a risk of injury. I understand the risk of continuing to participate with or
after a concussion or other injury. The Young Athlete may have to get medical care if there is a suspected concussion or other
injury. The Young Athlete also may have to wait 7 days or more and get permission from a doctor before playing sports again.

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
any time for the Young Athlete.

5. Personal Information. I understand that Special Olympics will be collecting the Young Athlete’s personal information as part
of participation, including name, image, address, telephone number, health information, and other personally identifying and
health related information provided to Special Olympics (“personal information”).
- I agree and consent to Special Olympics:
  - using the personal information in order to: confirm eligibility and safe participation; run trainings and events; share
    competition results (including on the Web and in news media); provide health treatment if the Young Athlete
    participates in a health program; analyze data for the purposes of improving programming and identifying and
    responding to the needs of Special Olympics participants; perform computer operations, quality assurance, testing,
    and other related activities; and provide event-related services.
  - using the personal information for communications and marketing purposes, including direct digital marketing through
    email, text message, and social media.
  - sharing personal information with (i) researchers, such as universities and public health agencies, that are studying
    intellectual disabilities and the impact of Special Olympics activities, (ii) medical professionals in an emergency, and
    (iii) government authorities for the purpose of assisting with any visas required for international travel to Special
    Olympics events and for any other purpose necessary to protect public safety, respond to government requests, and
    report information as required by law.
- I have the right to ask to see the personal information or to be informed about the personal information that is processed. I
  have the right to ask to correct and delete the personal information, and to restrict the processing of personal information if it
  is inconsistent with this consent.
- Privacy Policy. Personal information may be used and shared consistent with this form and as further explained in the Special
  Olympics privacy policy at www.SpecialOlympics.org/Privacy-Policy.aspx.
Emergency Care. If a parent or guardian is unavailable to consent or make medical decisions in an emergency, I authorize Special Olympics to seek medical care for the Young Athlete, unless I mark one of these boxes below. If either box is marked, an EMERGENCY MEDICAL CARE REFUSAL FORM must be completed.

I have a religious or other objection to receiving medical treatment (Not common.)I do not consent to blood transfusions. (Not common.)
PARENT/GUARDIAN: I am a parent or guardian of the participant. I have read and understand this form and have explained the contents to the participant as appropriate. By signing, I agree to this form on my own behalf and on behalf of the participant.*

I agreeI do not agree
Parent Guardian Name*

First NameLast Name
Date*

MonthDayYear
Date
Parent/Guardian Signature*

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YOUNG ATHLETES LIKENESS RELEASE FOR SPONSORS (OPTIONAL)
Special Olympics relies on sponsors and partners to help support our mission. We often use photos, videos and stories of our athletes to show the impact of support by companies that sponsor Special Olympics. If you wish to allow the Young Athlete’s likeness to be used in this way, please read and sign below.

I agree to the following:
- I give permission to Special Olympics, Inc., Special Olympics games organizing committees, and Special Olympics accredited Programs (collectively “Special Olympics”) and their sponsors and partners to use the Young Athlete’s likeness, photo, video, name, voice, and words (“Likeness”) to acknowledge the sponsors’ and partners’ support for Special Olympics.
- Special Olympics and its sponsors and partners will not use the Young Athlete’s Likeness to endorse commercial products or services.
- I understand neither the Young Athlete nor I will not be compensated for the use of the Young Athlete’s Likeness.
Parent/Guardian Signature

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Upon submitting the form, your application will be submitted to a Special Olympics Kansas staff member.

You will receive a copy of your submission at the email address you indicated. Email Lauren at vanvolkenburghl@soks.org if you have questions about this form or Young Athletes in general.
Should be Empty:

Special Olympics Kansas Young Athlete Registration

Parent/Guardian Information

Consent and Sign

YOUNG ATHLETES LIKENESS RELEASE FOR SPONSORS (OPTIONAL)