Fillable Form C2 - Athlete Release Form - Special Olympics printable pdf download

FORM C2 – Athlete Release Form

Instructions:

This form is required for all Special Olympics athletes and health program participants.

I want to participate in Special Olympics activities and agree to the following:

Able to Participate. I am able to participate in Special Olympics activities. I am submitting a completed MEDICAL FORM that

says it is safe for me to participate.

Photo Release. I give Special Olympics organizations permission to use my picture, video, name, voice, and words to promote

Special Olympics.

Overnight Stay. I understand that some Special Olympics activities may require an overnight stay in a hotel or someone else’s home.

If I have questions about this I will ask.

Emergency Care. If I need medical care in an emergency and I am not able to I consent at that time, I consent to emergency care.

Health Programs. If I choose to participate in a Special Olympics health program, I consent to health-related activities, physical

examinations, and treatment. I understand that this should not replace regular medical care. I understand that I can stop participating

or say no to treatment or any other activity at any time.

Personal Information. I understand that my personal information may be used and shared by employees and volunteers of Special

Olympics organizations to:



Make sure I am eligible and can participate safely in Special Olympics activities;



Coordinate training and competition events and compile competition results for Special Olympics, the media, and the public;



Input my information in a computerized database maintained by Special Olympics;



Provide healthcare treatment, make referrals, consult other doctors, and remind me about follow-up services;



Research, communicate, and respond to needs of Special Olympics participants (identifying information is removed if shared

with the public); and



Provide information to government authorities as necessary to obtain visas, protect health and safety, respond to government

requests, and report information as required by law.

PARTICIPANT NAME: ___________________________________________________________________________

PARTICIPANT SIGNATURE (Participant and Witness signatures required if Participant is over 18 years old and is signing on own behalf)

I have read and understand this release. By signing, I agree to this release.

Participant Signature: ______________________________________________________

Date: _______________________________

I have reviewed this Release Form with the Participant. I am satisfied that the Participant understands and agrees to this Release Form.

Witness Signature: ________________________________________________________

Date: _______________________________

Printed Name: ____________________________________________________________

Relationship: _________________________

PARENT/GUARDIAN SIGNATURE (required if Participant is under 18 years old or has a legal guardian)

I am a parent or guardian of the Participant. I have read and understand this release and have explained the contents to the Participant as appropriate.

By signing, I agree to this release on my own behalf and on behalf of the Participant.

Parent/Guardian Signature: __________________________________________________

Date: _______________________________

Printed Name: ____________________________________________________________

Relationship: _________________________

Form C2 - Athlete Release Form - Special Olympics

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