Athlete Registration

Student-Athlete Profile:
This form can ONLY be completed by a PARENT/CAREGIVER. The information collected will only be used by Special Olympics Ontario (SOO) for the 2020 School Championships.
The personal information you are providing to Special Olympics Ontario (SOO) is treated as strictly confidential by SOO and its partners. The collection and use of personal information by SOO is in accordance with the Ontario Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1980, CHAPTER M.58 and will be used for the purposes of identification and registration for the Games.*
The personal information you are providing to Special Olympics Ontario (SOO) is treated as strictly confidential by SOO and its partners. The collection and use of personal information by SOO is in accordance with the Ontario Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1980, CHAPTER M.58 and will be used for the purposes of identification and registration for the Games.
- I acknowledge and affirm I have read and understand the above.

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Athlete Name:*
First Last
School Name:*
Sport athlete is competing in:*
Athlete Gender:*
We use this information for accommodation purposes.
If other, please specify.
Athlete Birth Date:*
MM slash DD slash YYYY
Athlete dietary restrictions:*
Athlete Status:*
Athlete requires mobility assistive device: (if yes is answered here a follow up from the team will be sent)*
Athlete Home Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Axlanto-Axial Instability Profile:
Individuals who have Down Syndrome that have been tested positive for Atlanto-Axial Instability, shall not be permitted to participate in sport training and competition which, by their nature, result in hypertension, radical flexion or direct pressure on the neck or upper spine. Such sports training and competition activities include, but are not limited to: butterfly stroke and diving starts in swimming, pentathlon, high jump, powerlifting, artistic gymnastics, basketball, soccer, alpine skiing and any warm-up exercise placing undue stress on the head and neck. For more information and a copy of the Atlanto-Axial Examination form, contact your class teacher or visit our website at http://www.specialolympicsontario.com
Does this athlete have Down Syndrome?*
- Yes
- No
Date of last X-Ray:
Month
Day
Year
X-Ray results:
- Positive
- Negative

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Medical History:
Does this athlete have any mobility issues that would require special accommodations?*
- Yes
- No
If so, please provide details:
Does this Athlete have an intellectual disability?*
An intellectual disability is characterized by significant limitations both in intellectual functioning and in adaptive behaviour as expressed in conceptual, social, and practical adaptive skills.
- Yes
- No
Does this Athlete have an intellectual disability and a physical disability?*
A physical disability is identified as having closely related developmental disability with functional limitations in both general learning and adaptive skills; but the functional limitations are only due to: physical disabilities, emotional disturbances, behaviour disorders, specific learning disabilities, visual impairments, or sensory disabilities.
- Yes
- No
Please check all that apply:
- Food Allergies
- Sting/Bite Allergies
- Medicine Allergies
- Carries an EpiPen
- Asthma
- Carries an Inhaler
- Blindness or Visual Problems
- Bone or Joint Problems
- Chest Pain
- Concussion or Serious Head Injury
- Diabetes
- Down Syndrome
- Atlanto-Axial Instability
- Easy Bleeding
- Emotional/Psychological/Behaviour Problems
- Hearing Loss/Hearing Aid
- Major Surgery or Serious Illness
- Heat Stroke/Exhaustion
- High Blood Pressure
- Medications (if yes, please indicate below)
- Non-Verbal
- Seizures/Epilepsy/Fainting Spells (if yes, please indicate date of last episode below and if commonly reoccuring)
- Requires Assistance
- Uses Wheelchair
If you selected any of the boxes above please elaborate in the box below:
Please explain any medical issues and how to address them (i.e. list any allergies, response to seizures, medications required for specific circumstances, etc).
Please indicate any information that will benefit the athlete/coach training relationships (i.e. behaviour management, communications, limitations, etc.)
Please indicate any information that will benefit the athlete/coach training relationships (i.e. behaviour management, communications, limitations, etc.)
Does the athlete self-medicate?
- Yes
- No
Please list all medications.
Medication Name: Dosage: Times per Day

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Parent/Guardian Information:
Parent/Guardian Name:*
First Last
Relationship to athlete:*
Parent/Guardian Email Address:*
Please do not use Coach email address.
Home Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone Number:*
Cell Phone Number:*
Work Phone Number:

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Emergency Contact Information:
Emergency contact will only be utilized while at games.
Name:*
First Last
Phone Number:*
Relationship to athlete:*
If other, please indicate relationship:

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Healthy Athletes Release:
Special Olympics offers certain non-invasive health care services to athletes at local, provincial/territorial, national and World Games venues through the Healthy Athletes Program. These services may include individual screening assessments of health status and healthcare needs, provision of health education, routine preventative services (e.g. protective mouth guards), educational services and, in the case of vision and hearing deficit, provision of needed eye wear (glasses, swim goggles, protective eye wear) and hearing aids. Athletes are informed as to their health status and advised of the need for follow-up care. In addition, information collected at the time services are provided has been invaluable for developing policies, securing resources, and implementing programs to better meet the health needs of athletes. I understand that by signing below I consent to participate in the Special Olympics Healthy Athletes program that provides individual screening assessments of health status and health care needs in the areas of: vision; oral health, hearing; physical therapy; and a variety of health promotion areas (height, weight, sun protection, etc.). I understand there is no obligation for me to participate in the Healthy Athletes Program should I decide not to participate. Provision of these healthy services is not intended as a substitute for regular care. I also understand that I should seek my own independent medical advice and assistance irrespective of these provisions responsible for my health. I understand that information that is gathered as part of the screening process may be used in group form (anonymously) to assess and communicate the overall health needs of athletes and to develop programs to address those needs.
Please select one...*
I am:*
Please note: If the athlete is under the age of 18 this form MUST be completed by a PARENT or GUARDIAN only. Coaches cannot complete this form for athletes.
- The parent or guardian of the athlete named on this form.
- The athlete named on this form (athlete can only complete this form if over the age of 18)
Parent/Guardian Signature*
An athlete can sign this form is they are over the age of 18.

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Athlete Code of Conduct:
All athletes shall maintain high standards of conduct, which includes self-control and responsible behaviour. An athlete should consider the well being of others and display courtesy and good manners. Athletes shall avoid profane or abusive language and disruptive behaviour including behaviour that is dangerous to self and/or others including acts of violence, harassment, physical or sexual abuse. All rules of competition must be abided, especially the Special Olympics Ontario Official Sports Rules. Athletes must abstain from the use or consumption of alcoholic beverages, tobacco products, marijuana and/or illegal substances when participating in any Special Olympics sponsored/sanctioned activities. These activities include, but are not limited to, training/practice sessions and competition events. It is required that all athletes abstain from all illegal activity. Athletes must honour the Special Olympics Oath. Special Olympics Ontario has sole and absolute discretion as to any disciplinary actions to be taken if a person violates the Athlete Code of Conduct. Any action taken is predicated with the good faith belief of Special Olympics Ontario that the disciplinary action is appropriate. Any disciplinary action that is taken can be appealed as per the Disciplinary and Corrective Action Policy and Procedures provided by the Provincial Office. Immediate disciplinary action, including suspension from the Games in which the athlete will be sent home immediately at their own expense, may be imposed for any of the following: Engaging in any illegal or criminal activity when the Special Olympics Provincial office has a good faith belief that there has been illegal activity, whether or not there has been a formal charge made; Any person behaving in a manner that is inherently dangerous to him/herself or others. This includes any violent acts, harassment, or any behaviour which impacts the integrity of Special Olympics programs; The use or consumption of alcohol, marijuana or illegal substances that may affect the safety and well being of other athletes. This includes but is not limited to all training/practice sessions, the duration of competition events, or any other Special Olympics sponsored or sanctioned activity where athletes are present; Any person accused or suspected of abusing (physical or sexual), molesting, assaulting, or harassing another person.
Affirmation of Code of Conduct:*
Please note: If the athlete is under the age of 18 this form MUST be completed by a PARENT or GUARDIAN only. Coaches cannot complete this form for athletes.
- I hereby certify that I have reviewed, understood and agreed to this Code of Conduct.
Type your full name to verify your understanding of the above statements:*
Parent/Guardian Signature*
Only athletes over the ages of 18 can sign this form.

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General Waiver:
In consideration of my participation in events organized in anticipation of the Special Olympics Ontario School Championships, I represent that I understand the nature of the event and that I and/or my minor child am/are qualified, in good health and in proper physical condition to participate in such event(s). I acknowledge that my attendance at an event for the Special Olympics Ontario School Championships, or my use of the facilities, is done at my own risk, and I hereby release, discharge, and covenant not to sue Special Olympics Ontario, Special Olympics Canada Inc., their respective administrators, directors, agents, officers, volunteers, and employees, emergency personnel, other participants, any sponsors, advertisers, and, if applicable, owners, and lessors of premises on which the events organized in anticipation of the Special Olympics Ontario School Championships takes place, (each considered on the “RELEASEE’s herein) from all liabilities, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the “releasees” or otherwise, including negligent rescue operations; and I further agree that if, despite the release, waiver or liability, and assumption of risk I, or anyone on my behalf and/or on behalf of my minor child, make a claim against any of the releasee, I will indemnify, save, and hold harmless each of the releasees from any such loss, liability, damage, of cost which each of the releasees may incur as the result of such claim. I agree to abide by the Special Olympics Canada Inc. rules, policies, procedures and Code of Behavior. If I am unable to be consulted in case of necessity, Special Olympics Canada Inc. is authorized at my account to take such measures and arrange for such medical and hospital treatment as is deemed advisable for my health and well-being. Any and all references to Special Olympics Canada Inc. include and apply equally to Special Olympics Ontario Inc. AUTHORIZATION TO USE NAME AND LIKENESS I hereby authorize Special Olympics Canada Inc. and/or their partners including Police Services to use my name, likeness, statements and other identifying information, including in photographs, video and recordings for the purposes of publicizing and promoting Special Olympics, and to raise funds for Special Olympics, worldwide, in perpetuity. This authorization includes use in any media now known or hereinafter devised throughout the universe, including but not limited to print and on the World Wide Web. I understand that I will not be compensated for such use and that Special Olympics is not obligated to use my name, likeness or statements or other identifying information. All participants under the age of 18 must have this release/waiver signed by a parent/guardian 18 years or older. By signing this release/waiver of liability, I acknowledge the assumption of risk, and indemnity and fully understand it.
Affirmation of General Waiver:*
Please note: If the athlete is under the age of 18 this form MUST be completed by a PARENT or GUARDIAN only. Coaches cannot complete this form for athletes.
- I affirm that I have read the above release and that the information given is true and complete
Type your full name to verify your understanding of the above statements:*
Parent/Guardian Signature*
Only athletes over the ages of 18 can sign this form.
Witness Name:*
Witness Signature:*

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Step 1 of 9

Student-Athlete Profile:

Axlanto-Axial Instability Profile:

Medical History:

Parent/Guardian Information:

Emergency Contact Information:

Healthy Athletes Release:

Athlete Code of Conduct:

General Waiver:

Acknowledgement of Traditional Land

District Sites

Finance & Administration

Careers

News & Media

Other Special Olympics Sites

District Sites

Finance & Administration

Careers

News & Media

Other Special Olympics Sites

District Sites

Finance & Administration

Careers

News & Media

Other Special Olympics Sites

Medication Name:	Dosage:	Times per Day