• 2026 Fall Games Healthy Athletes Volunteer Registration

    Thank you for volunteering to be a part of Special Olympics Vermont's 2026 Fall Games Healthy Athletes Screening on September 13th, 2026 at Collins Perley Sports & Fitness Center! Please complete the form below.
  • Volunteer Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Today's Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • I will be volunteering for:*
  • What shift would you like to volunteer for? (Please note, more specific times to come).*
  • Format: (000) 000-0000.
  • Volunteer Release

    Please read and sign below.
  • Please read the following volunteer release and sign below. 

     

    I agree to the following:

    1. Ability to Participate. I am physically able to take part in Special Olympics activities. I know there is a risk of injury.
    2. Likeness Release. I give permission to Special Olympics, Inc., Special Olympics games/local organizing committees, and Special Olympics accredited Programs (collectively “Special Olympics”) and Special Olympics partners and sponsors to use my likeness, photo, video, name, voice, words, and biographical information to promote Special Olympics, raise funds for Special Olympics, and acknowledge partners’ and sponsors’ support for Special Olympics.
    3. Emergency Care. If I am unable, or my guardian is unavailable, to consent or make medical decisions in an emergency, I authorize Special Olympics to seek medical care on my behalf.
    4. Personal Information. I understand that Special Olympics will be collecting my personal information as part of my participation, including my name, image, address, telephone number, health information, and other personally identifying and health related information I provide to Special Olympics (“personal information”).
      1. I agree and consent to Special Olympics:
        1. using my personal information in order to: make sure I am eligible and can participate safely; run trainings and events; share competition results (including on the Web and in news media); provide health treatment if I participate 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.
        2. using my contact information for communicating with me about Special Olympics.
        3. sharing my personal information with (i) medical professionals in an emergency, and (ii) government authorities for any purpose necessary to protect public safety, respond to government requests, and report information as required by law.
      2. I have the right to ask to see my personal information or to be informed about the personal information that is processed about me. I have the right to ask to correct and delete my personal information, and to restrict the processing of my personal information if it is inconsistent with this consent.
      3. 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.
    5. Waiver and Liability Release. 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. In consideration of being allowed to participate in any way in Special Olympics activities, the undersigned acknowledges, appreciates, and agrees that while particular rules and personal discipline may reduce the risk, the risk of illness (including communicable diseases), injury (including concussion), disability, and death does exist. I release and agree not to sue any Special Olympics organization, its directors, agents, volunteers, and employees, and other participants (“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. 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.
  • Special Olympics, Inc. Health Programs Hold Harmless Agreement Information

    Please read and complete the following.
  • The use of the attached Harmless Agreement (“Agreement”) is a risk management method that Special Olympics, Inc. (“SOI”) has put in place to prevent SOI and Special Olympics Programs (“Programs” and together with SOI, “Special Olympics”) and their registered healthcare providers, clinicians, residents, and health professional students (“Clinical Volunteer” and collectively, “Clinical Volunteers”) from suffering financial damage for an incident that they did not cause related to their services on behalf of Special Olympics Health programming including Healthy Athletes® and Healthy Communities® (“Health Programs”).

    The Agreement applies to Clinical Volunteers providing non-invasive examinations, treatments, and educational materials to Special Olympics athletes while acting in their professional capacities.

    The following summary provides an overview of the Agreement, as well as malpractice insurance and medical licensing requirements for Clinical Volunteers:

    Protection for Special Olympics:

    If a Clinical Volunteer does something in his or her professional capacity that causes Special Olympics to be sued, there are three potential scenarios that would apply:

    • If a Clinical Volunteer has malpractice coverage that applies while volunteering and the policy includes coverage for contractual liability, then their personal malpractice coverage would cover the individual and Special Olympics. In this case, the Special Olympics medical malpractice policy (“SO Coverage”) would come into play only if the limits were exhausted under the Clinical Volunteer’s malpractice policy;
    • If a Clinical Volunteer has malpractice coverage but the policy does not include contractual liability, the Clinical Volunteer’s personal malpractice coverage would respond on behalf of the Clinical Volunteer on a primary basis. The SO Coverage would apply on behalf of Special Olympics on a primary basis and on behalf of the Clinical Volunteer on an excess basis; or
    • If a Clinical Volunteer does not have medical malpractice coverage, SO Coverage would apply on a primary basis on behalf of Special Olympics and the Clinical Volunteer.

    Protection for Clinical Volunteer:

    If Special Olympics does something to cause a Clinical Volunteer to be brought into a lawsuit that is not related to the provision of medical services (for example, an athlete slips on a wet floor in a health venue and sues a Clinical Volunteer), Special Olympics general liability policy is designed to provide coverage for third-party claims of bodily injury.

    Special Olympics Medical Malpractice Coverage:
    The Special Olympics medical malpractice policy provides coverage for Clinical Volunteers including supervised health professional students (“Students”) acting in their professional capacity in compliance with Special Olympics procedures.

    Limit of Liability:

    $1,000,000 per occurrence/$3,000,000 policy in the aggregate.

    Notes:

    • Coverage is excess coverage over any other valid collectible insurance.
    • Clinical Volunteers licensed in a different state, including Students, must be supervised by a professional licensed in the state where the Health Program is taking place.
    • Coverage applies only for services and activities taking place inside the United States.
    • Liability and legal requirements for Clinical Volunteers at Health Events outside of the United States are dictated by the laws of that country, province, state, etc. To protect both the Clinical Volunteers and Special Olympics, however, Clinical Volunteers at Health Programs outside the United States also MUST sign the Agreement prior to providing any screenings or other medical
      services.

    Licensing Requirements:

    Special Olympics requires that all Clinical Volunteers be appropriately licensed (or subject to an exemption under local law) in the jurisdiction in which they are volunteering. Any request for exceptions to these licensing requirements must be reviewed and approved in writing by both the local SO Program’s Health Staff and Special Olympics health department before an exception is granted.

    Document Retention:

    SO Programs should keep signed Agreements on file (electronically or hard copy) for at least 10 years after the Clinical Volunteer has stopped providing their services pursuant to the Agreement.

     

     

     

  • Special Olympics Inc., Hold Harmless Agreement for Clinical Volunteers

    The individual(s) listed below shall defend, hold harmless and indemnify Special Olympics, Inc. (“SOI”), and the Special Olympics Program (each an “SO Program”) where the Health Program, defined below, is being held, and each organization’s directors, officers, agents, employees, and volunteers from and against any and all liability, loss, expense (including reasonable attorney’s fees), or claims for injury or damages that are caused by or resulting from the negligent or intentional acts or omissions by the person named below who provides services as part of Healthy Athletes®, Healthy Communities®, or any other Special Olympics health programming (collectively, “Health Program(s)”). SOI and/or the SO Program, as applicable, shall defend, hold harmless and indemnify the individual(s) listed below against any and all liability, loss, expense (including reasonable attorney’s fees), or claims for injury or damages that are caused by or that are a result of the negligent or intentional acts or omissions of SOI and/or the SO Program, and each organization’s directors, officers, agents, employees, and volunteers with regard to Health Programs.
  • SO Program: Vermont

    Event Name: 2026 Fall Games

    Event Date: 9/13/2026

    SO Program Representative Name, Title: Alex Gilman, Senior Health Programs Manager

    Signature: 

  • Do you have a valid medical license to practice in the jurisdiction in which services will be delivered?*
  • Are you a clinician, health professional student, resident, or licensed healthcare provider in a different jurisdiction?*
  • Do you have medical malpractice insurance?*
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: