Fillable Athlete Release Form - Special Olympics printable pdf download

ATHLETE RELEASE FORM

I want to take part in Special Olympics and agree to the following:

Able to Participate. I am able to take part in Special Olympics. I know there is a risk of injury.

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

Special Olympics.

Overnight Stay. For some events, I may stay in a hotel or someone’s home. If I have questions, I will ask.

Emergency Care. If I am unable, or my guardian is unavailable, to make medical decisions in an emergency, I

authorize Special Olympics to seek medical care on my behalf, unless I check one of these boxes:

 I have a religious or other objection to receiving medical treatment.

 I do not consent to blood transfusions.

(If either box is checked, an EMERGENCY MEDICAL CARE REFUSAL FORM must be completed.)

Health Programs. If I take part in a health program, I consent to health activities, exams, and treatment. This

should not replace regular health care. I can say no to treatment or anything else any time.

Personal Information. I understand my information may be used and shared by Special Olympics to:



Make sure I am eligible and can participate safely;



Run trainings and events and share results;



Put my information in a computer system;



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



Research, share, and respond to needs of Special Olympics athletes (identifying information removed if

shared publically); and



Protect health and safety, respond to government requests, and report information required by law.

I can ask to see and change my information.

I understand Special Olympics is a global organization with headquarters in the United States of America. I

consent to Special Olympics processing my information in countries with different privacy and data security laws,

including the United States of America.

ATHLETE NAME: __________________________________________

ATHLETE SIGNATURE (required for athlete over 18 years old with capacity to sign legal documents)

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

Participant Signature: ____________________________________________ Date: ____________________________

PARENT/GUARDIAN SIGNATURE (required for athlete under 18 years old or lacking 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: _______________________________________ Date: ____________________________

Printed Name: _________________________________________________ Relationship: ______________________

Updated 15 May 2017

Athlete Release Form - Special Olympics