Athlete Application - Special Olympics CO

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The mission of Special Olympics is to provide year-round sports training and athletic competition in a variety of Olympic-type sports for children and adults with intellectual disabilities, giving them continuing opportunities to develop physical fitness, demonstrate courage, experience joy and participate in a sharing of gifts, skills and friendship with their families, other Special Olympics athletes and the community.

Info@SpecialOlympicsCO.org

12450 E Arapahoe Rd Suite C
Centennial, CO 80112

Office hours:
Monday – Friday 8:30am – 5:00pm

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Athlete Application

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Athlete Application

Special Olympics Colorado Online Athlete Application!

*Required for participation as an athlete

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A few important items before proceeding:

The application is required annually for participation by all athletes (with intellectual disabilities). This form asks for contact information, health history, waivers, releases and code of conduct. These help us create a safe and supportive environment, ensuring everyone's health, safety, and dignity are respected. Once approved, the application clears an athlete for participation for one year across all Special Olympics Colorado’s sports and events.
Sport Physical Exam IS ONLY REQUIRED IF YOU:
1. Currently have participation restrictions limiting your participation in any sports or
2. Have had a concussion in the last 30 days.
3. Sports Physical Exam Guidelines:
  - Click here to view and download the Special Olympics Sport Medical Exam Form
  - We accept: Any sports physical, including CHSAA physicals (all pages should be provided). It must minimally be completed and signed by a Licensed Medical Practitioner (for example, Physician, Registered Nurse Practitioner, or Physician Assistant, but not a Chiropractor) who is qualified to conduct physical examinations and prescribe medications, and clear an athlete to participate in sport.
  - We do not accept: Encounter Summaries, Visit Summaries, Health Appraisals or a General Appraisal that does not specifically contain a statement that directly clears for Sport Participation.
Web Browser: Make sure you are using the Chrome web browser (other web browsers are not recommended and may cause difficulties). Safari is not supported or recommended. To install Chrome on your computer, please click here.
Save & Continue: You can save your application and come back later by clicking "Save & Continue Later" and entering an email address. You will receive a link to your saved application which is good for 30 days.
Email Confirmation: You will receive a copy of your submitted application upon submission to an email of your choice.
NEED HELP? If you are having trouble or have any questions please visit our Application Resources by clicking here.

Has participant been diagnosed with an Intellectual Disability/Delay/Disorder?(Required)

What is Intellectual Disability?

Yes

No

To become a Unified Partner, please complete the application linked below:

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Section Break

Has a doctor ever limited your participation in sports?(Required)

If yes, has a doctor CURRENTLY limited your sports participation?(Required)

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Set Limited Participation

Athletes with current sport limitations must complete a physical exam and release from a doctor.

Have you ever had a concussion?(Required)

Please specify how many concussions you have had in your life:(Required)

Please enter a number from 1 to 10.

Date of last concussion:(Required)

Note: Athletes are ineligible to participate if you have had a concussion within the past 30 days.

MM slash DD slash YYYY

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Days Since Concussion

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Set Concussion

Athletes who have experienced a concussion within the past 30 days must complete a physical exam and release from a doctor or wait and apply after the 30 days has passed.

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Set for Clearance

Cleared to Participate in Sports

In order to proceed with the application, you will be required to upload the sports physical exam that has been completed by a licensed physician.(Required)

If a concussion was experienced less than 30 days ago, a doctors release must also accompany the physical exam.

Yes, I have a copy of my completed Sports Physical Exam ready to upload - It is signed, dated and clears the athlete for participation in Sports

No, I do not have a copy of my completed Physical Exam ready for upload

Please Return When You Have a Copy of Your Physical Exam to Upload.

Physical Examination Form - English
Physical Examination Form - Spanish

What is the Exam Date written by the doctor on the sports physical?(Required)

If no date is provided, please have doctor fill in the exam date before uploading the file.

MM slash DD slash YYYY

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Days Since Exam

Upload Athlete Physical Examination Form Here(Required)

If you DO NOT have the Physical Exam to upload, please save and come back when you have it to upload.

Drop files here or

Max. file size: 50 MB.

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Set Exam for Next

Athlete Information

Legal Name(Required)

Please enter the participant’s legal name. The following question will gather the athlete’s nickname or preferred name.

First Middle Last Suffix

Nickname or Preferred Name

Enter only if different from legal name.

Date of Birth(Required)

Month

Day

Year

Please check date format is mm/dd/yyyy and/or age is greater than 2.

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Age

Is Athlete their own Guardian?(Required)

Gender(Required)

Email(Required)

Enter Email Confirm Email

Phone Number(Required)

Phone Type(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

County(Required)

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Region

Race/Ethnicity

Check all that apply

American Indian / Alaskan Native

Asian / Asian American

Black / African American

Hispanic, Latino/a, or Spanish

Middle Eastern / North African

Native Hawaiian / Other Pacific Islander

White / Caucasian

Unknown

Prefer not to answer

Other Race or Ethnicity

Other Race/Ethnicity Selected:(Required)

Please input race/ethnicity.

Language(s) Spoken by Athlete

Check all that apply

English

Spanish

French

American Sign Language (ASL)

Other

Other Language(s) Selected:

Please input other languages spoken/understood by athlete.

Parent/Guardian Information

Required if athlete is a minor or otherwise has a legal guardian.

Parent/Guardian Name(Required)

First Last Suffix

Relationship to Athlete:(Required)

If other, please describe:(Required)

Phone(Required)

Phone Type(Required)

Parent/Guardian Email(Required)

Address(Required)

Same as Athlete

Street Address Address Line 2 City State ZIP Code

Emergency Contact is the Same as Parent/Guardian(Required)

Emergency Contact

Emergency Contact Name(Required)

First Last

Emergency Contact Email(Required)

Emergency Contact Phone(Required)

Phone Type(Required)

Relationship to Athlete:(Required)

If other, please describe:(Required)

Associated or Secondary Conditions / Diagnoses

Associated Conditions(Required)

Check all that apply.

Autism

Cerebral Palsy

Down Syndrome

Epilepsy

Fetal Alcohol Syndrome

Fragile X Syndrome

Marfan Syndrome

Spina Bifida

Unknown

Other

Please specify other known intellectual disability diagnoses:(Required)

Assistive Devices and Accommodations

Do you use any of the following? Check all that apply.

Mobility(Required)

Check all that apply.

None

Braces or crutches

Prosthetics

Removable orthotics

Walker

Wheelchair

Lifestyle Aids(Required)

None

CPAP

Dentures

Glasses, contact lenses, or protective eyewear

Communications(Required)

None

Hearing Aid

Communication Devices

Sign Language

Medical Devices(Required)

None

Implantable Cardioverter Defibrillator (ICD)

Implantable device for seizure management

VP Shunt

Pacemaker

Please list any other assistive devices that you use:

Do you have a specific dietary requirement?(Required)

If yes, please specify:(Required)

General Health Questions

Do you have a heart condition?(Required)

Do you have asthma?(Required)

Do you have diabetes that requires you to take insulin?(Required)

Do you have a vision impairment?(Required)

Do you have a hearing impairment?(Required)

Do you have a bleeding disorder?(Required)

Do you have epilepsy or any type of seizure disorder?(Required)

Do you have sickle cell disease?(Required)

Please describe the current limitation from participating in sports:(Required)

Because you indicated you have a current limitation from participating in sports, please describe your limitation.

Do you have any behavioral, mental health and/or sensory conditions?(Required)

Please specify any behavioral, mental health and/or sensory conditions:(Required)

Do you have severe allergies that require the use of an EpiPen?(Required)

If yes, specify if it is to any of the following:(Required)

Insect Stings

Food

Medication/drugs

Latex

Other

If other, please specify:(Required)

Insurance Provider Information

Are you currently enrolled in(Required)

Please select all that apply

Medicare

Medicaid

None

Other

Primary Insurance Provider

Other Primary Insurance(Required)

You selected "Other", please provide name of Primary Insurance provider.

Medication & Treatment

Are you taking any prescription or over-the-counter medications or treatments?(Required)

Including birth control pills, insulin, multivitamins, allergy shots or pills, EpiPen, asthma inhalers, epilepsy medication, anti-inflammatory medication, supplements of any kind, etc.

If yes, please list(Required)

Medication, Vitamin or Supplement Name

Dosage

Times per Day

Is anyone assisting the athlete in completing this form?(Required)

Name of Person Completing Form:(Required)

First Last

Relationship to Athlete:(Required)

Additional Documentation

Do you have any supporting documentation to upload to the application?

Yes

Supporting Documentation

Drop files here or

Max. file size: 50 MB.

Waivers, Releases, and Policies

Please read the following information and check boxes fully before signing. I agree to the following:

1. ABILITY TO PARTICIPATE: I am physically able to take part in Special Olympics / Special Olympics Colorado activities.

2. LIKENESS RELEASE. I give permission to Special Olympics, Inc., Special Olympics games organizing committees, Special Olympics accredited Programs (collectively “Special Olympics”), as well as official Special Olympics supporters and partners that have authorization from Special Olympics, to use my likeness, photo, video, name, voice, words, biographical information and similar or related material (my “likeness”) to promote Special Olympics and raise funds for Special Olympics. I understand that my likeness may be used in all forms of media in local or global campaigns – including those by supporters and partners of Special Olympics – but understand that my likeness will not be used to endorse commercial products or services. I understand that I will not be compensated for the use of my likeness.

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, unless I mark one of these boxes:

Care Refusal

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

I do not consent to blood transfusions.

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

4. OVERNIGHT STAY. For some events, overnight accommodations may be required. If I have questions, I will contact my Special Olympics Program.

5. HEALTH PROGRAMS. If I take part in a health program, I consent to health activities, screenings, and treatment. This should not replace regular health care. I have the right to decline Health programming treatment (which is different from sideline or emergency medical care) at any time.

6. 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”). I agree and consent to Special Olympics:

a). 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.

b). using my contact information for communicating with me about Special Olympics.

c). sharing my personal information confidentially with (i) researchers such as universities and public health agencies that are studying intellectual disabilities and the impact of Special Olympics activities, (ii) medical professionals in an emergency, and (iii) government authorities for the purpose of assisting me with any visas required for international travel to Special Olympics events and for any other purpose necessary to protect public safety, respond to government requests, and report information as required by law.

d). 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.

PRIVACY POLICY. Personal information may be used and shared consistent with this form and as further explained in the Special Olympics privacy policy.

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

If I (or the athlete) have been diagnosed with or experienced any of the following symptoms that have increased in severity over the past three years – difficulty controlling bowels or bladder; numbness or tingling in legs, arms, hands, or feet; weakness in arms, legs, hands or feet; burner/stinger/pinches nerve, pain in neck, back shoulders, arms, hands, buttocks, legs or feet; spasticity or paralysis – I must obtain a review and permission from a licensed medical practitioner to train and/or participate in Special Olympics activities.

WAIVER AND RELEASE OF LIABILITY / ASSUMPTION OF RISK / INDEMNIFICATION

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;
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,
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 Signature

Athlete is 18 or older and their own legal guardian.

Athlete Name(Required)

First Last Suffix

ATHLETE SIGNATURE (required for adult athlete with capacity to sign legal documents)(Required)

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

Parent/Guardian Signature

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

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 Name(Required)

First Last Suffix

Signers Relationship to Athlete:

Signature Date

MM slash DD slash YYYY

Code of Conduct

Athlete Code of Conduct(Required)

Special Olympics is rooted in the values of respect, fairness, and the true spirit of sport. We expect all athletes and Unified partners to uphold these values on and off the field.

By participating in Special Olympics, athletes and Unified partners agree to follow this Code of Conduct during all Special Olympics events, competitions, and any time they are representing their team, Special Olympics, or Special Olympics Colorado (SOCO).

Sportsmanship

I will practice good sportsmanship.
I will act in ways that bring respect to me, my coaches, my team and Special Olympics.
I will not use bad language.
I will not swear or insult other people.
I will not fight with other athletes, coaches, volunteers or staff.

Training and Competition

I will train regularly.
I will learn and follow the rules of my sport.
I will listen to my coaches and the officials and ask questions when I do not understand.
I will always try my best during training and competitions.
I will not "hold back" in preliminaries just to get into an easier final competition.

Responsibility for My Actions

I will not make inappropriate or unwanted physical, verbal or sexual advances on others.
I will not drink alcohol, smoke or take illegal drugs while representing Special Olympics at training sessions, competition or other events or for the purpose of improving my performance.
I will obey all laws and Special Olympics rules.

Code of Conduct Acknowledgment

Special Olympics Colorado is committed to creating a safe and respectful environment for everyone. All participants are expected to follow the Code of Conduct, and any concerns or violations will be reviewed by the Code of Conduct Review Committee.

I understand that if I do not follow the Code of Conduct, I may lose the opportunity to participate in Special Olympics activities.

I agree to the Athlete Code of Conduct

Upon submission, you will receive a copy of this application. Would you like anyone else to receive a copy of YOUR application via email? (e.g. a coach, parent)

NOTE: This application contains personal information so be cautious when deciding who will receive a copy.

Yes

No

Email a copy of this application here:(Required)

Enter email address of person you wish to receive a copy of this application.

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?

Yes

No

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12450 E Arapahoe Rd Suite C
Centennial, CO 80112
720-359-3100
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