U.S. Athlete Registration Form

WAIVER AND RELEASE OF LIABILITY / ASSUMPTION OF RISK / INDEMNIFICATION
In consideration of being allowed to participate in any way in Special Olympics activities, the undersigned acknowledges, appreciates, and agrees that:
1. While particular rules and personal discipline may reduce this risk, the risk of illness (including communicable diseases), injury (including concussion), disability, and death does exist;
2. If I observe 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 Special Olympics representative immediately; and,
3. I understand the risks involved with participation in Special Olympics activities. I fully accept and assume all risks and all responsibility for losses, costs, and damages I may incur as a result of my participation. To the fullest extent of the law, I release and agree not to sue any Special Olympics organization, its directors, agents, volunteers, and employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable owners and lessors of premises on which any Special Olympics activity is occurring (“Releasees”) related to any liabilities, claims, or losses on my account caused or alleged to be caused in whole or in part by the Releasees even if arising from the negligence of the Releasees. I have read this release of liability and assumption of risk provision, fully understand its terms, acknowledge that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement. I further agree that if, despite this release, I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify and hold harmless each of the Releasees from any such liabilities, claims, or losses as the result of such claim. I agree that if any part of this form is held to be invalid, the other parts shall continue in full force and effect.
Athlete Name:*
ATHLETE SIGNATURE
(required for adult athlete with capacity to sign legal documents)

I have read and understand this form. If I have questions, I will ask. By signing, I agree to this form.
I have read and understand this form. If I have questions, I will ask. By signing, I agree to this form. *

Powered by Jotform SignClear
Date:*

MonthDayYear
PARENT/GUARDIAN SIGNATURE
(required for athlete who is a minor or lacks capacity to sign legal documents)

I am a parent or guardian of the athlete. I have read and understand this form and have explained the contents to the athlete as appropriate. By signing, I agree to this form on my own behalf and on behalf of the athlete.
Parent/Guardian Signature:*

Powered by Jotform SignClear
Date:*

MonthDayYear
Date
Printed Name:*
Relationship:*
EVALUATION AND RESEARCH (Optional)

Special Olympics wants to help our athletes and their families stay healthy and happy. We may take part in research studies and would share information for your potential participation. All studies will be checked by the Special Olympics Chief Health Officer.
Would you or your family be interested in learning about research studies?*

YesNo
How did you find out about Special Olympics New Jersey?
Other
Type of Advertisement
EMERGENCY MEDICAL CARE REFUSAL FORM – ATHLETE COMPLETION
EMERGENCY MEDICAL CARE REFUSAL FORM – ATHLETE COMPLETION
(To be completed by adult athlete with capacity to sign legal documents)

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

I am a Special Olympics athlete with capacity to sign documents on my own behalf and 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.
YOU MUST MARK THE BOX AND WRITE YOUR INITIALS NEXT TO ONE STATEMENT TO CONFIRM YOUR INTENT:*

I DO NOT CONSENT TO ANY KIND OF MEDICAL TREATMENT, EVEN IN A LIFE-THREATENING EMERGENCY.I DO NOT CONSENT TO BLOOD TRANSFUSIONS, EVEN IN A LIFE-THREATENING EMERGENCY. I CONSENT TO ALL OTHER KINDS OF EMERGENCY MEDICAL CARE.
2. Printed Instructions. I agree to carry printed instructions that describe my religious or other objections to medical treatment and how I wish the person accompanying me to respond if I get sick or hurt and cannot speak for myself. I agree to carry these printed instructions with me at all times during my participation in any Special Olympics activity, including during meal times, in overnight accommodations, at training sessions and competitions, and during travel to and from Special Olympics activities.

3. Friend or Family Accompaniment. I understand that I must be accompanied by an adult friend or family member in order for that person can take personal responsibility for me during a medical emergency where I am unable to speak for myself.

4. Emergency Medical Care If Athlete Is Not Accompanied. I understand that, if I am not carrying the printed instructions or the accompanying adult is not present and actively taking personal responsibility for me during a medical emergency where I am unable to speak for myself, Special Olympics may seek emergency medical care for me as recommended by medical professionals responding to the emergency.

5. Liability Release. 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 me 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 withholding consent to emergency medical care on religious or other grounds. For this form, “Special Olympics” means all Special Olympics organizations.
Athlete Signature
Athlete First Name:
Athlete Middle Name:
Athlete Last Name:
E-mail:
Athlete Signature - I have read and understand this form. If I have questions, I will ask. By signing, I agree to this form.

Powered by Jotform SignClear
Date

MonthDayYear
Date
Accompanying Adult Signature
By signing, I agree to accompany the athlete during Special Olympics activities and take personal responsibility for the athlete during an emergency. I understand the extent to which the athlete does not consent to emergency medical care and agree to act in accordance with the athlete’s wishes as I understand them.
Signature Of Accompanying Adult

Powered by Jotform SignClear
Date

MonthDayYear
Date
Accompanying Adult Printed Name:
Accompanying Adult Relationship:
Emergency Medical Care Refusal Form - Parent of Guardian Completition
(To be completed by parent or guardian of athlete who is a minor or lacks capacity to sign legal documents)

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

I am the parent/guardian of the athlete named below and 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 MARK THE BOX AND WRITE YOUR INITIALS NEXT TO ONE STATEMENT TO CONFIRM YOUR INTENT:

I DO NOT CONSENT TO ANY KIND OF MEDICAL TREATMENT, EVEN IN A LIFE-THREATENINGEMERGENCY.I DO NOT CONSENT TO BLOOD TRANSFUSIONS, EVEN IN A LIFE-THREATENING EMERGENCY. ICONSENT TO ALL OTHER KINDS OF EMERGENCY MEDICAL CARE.
2. Accompaniment of Athlete. I understand that I must be present in order to take personal responsibility for the athlete if any medical treatment is to be refused on the athlete’s behalf in 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.

3. Emergency Medical Care If Athlete Is Not Accompanied. I understand that, if I am not present and actively taking personal responsibility for the athlete during a medical emergency, Special Olympics may seek emergency medical care for the athlete as recommended by medical professionals responding to the 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 withholding consent to emergency medical care on religious or other grounds. For this form, “Special Olympics” means all Special Olympics organizations.
Athlete Name:
Email:
example@example.com
Parent/Guardian Signature
I am a parent or guardian of the athlete. I have read and understand this form and have explained the contents to the athlete as appropriate. By signing, I agree to this form on my own behalf and on behalf of the athlete. This release shall be binding upon me, the athlete and our respective heirs and legal representatives.
Parent/Guardian Signature:

Powered by Jotform SignClear
Date:

MonthDayYear
Date
Parent/Guardian Printed First Name:
Parent/Guardian Printed Last Name:
Parent/Guardian Relationship:
Should be Empty:

	Medication, Vitamin, or Supplement Name	Dosage	Times per day
1
2
3
4
5
6
7
8
9
10

U.S. Athlete Registration Form

Athlete Information

Parent/Guardian Information

Emergency Contact

Associated Conditions - Mandatory

Assistive Devices and Accommodations

General Health Questions

Medication and Treatment - Please list:

WAIVERS, RELEASES, AND POLICIES

SYMPTOMS FOR SPINAL CORD COMPRESSION and ATLANTOAXIAL INSTABILITY (For athlete with Down syndrome only)

WAIVER AND RELEASE OF LIABILITY / ASSUMPTION OF RISK / INDEMNIFICATION

EMERGENCY MEDICAL CARE REFUSAL FORM – ATHLETE COMPLETION

Athlete Signature

Accompanying Adult Signature

Emergency Medical Care Refusal Form - Parent of Guardian Completition

Parent/Guardian Signature