Athlete Name: *

First Name

Last Name

Athlete Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Athlete Date of Birth: *

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DD

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Athlete Home Phone #: *

(###)

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Athlete Cell Phone #:

(###)

###

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Emergency Contact Name: *

First Name

Last Name

Emergency Contact Phone #: *

Country

(###)

###

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Athlete Doctor's Name *

First Name

Last Name

Athlete Doctor's Phone # *

Country

(###)

###

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Please select ALL sports for which you would like to register: *

* Please note that registration numbers may be limited by facility and volunteer availability.

Basketball (Monday Evenings)

5-Pin Bowling (Saturday Afternoons)

Curling (Sunday Afternoons)

Floor Hockey (Tuesday Evenings)

Swimming (Wednesday Evenings)

Name of person completing registration form: *

First Name

Last Name

Phone #: *

(###)

###

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Confirmation: *

I hereby certify the above information to be correct.

SOO Resource Review 1 *

I have read and understand SOO’s Infection Prevention and Control Measures (IPCM).

SOO Resource Review 2 *

I have read and understand “A Guide for Students & Athletes of All Abilities: e-booklet (Rowan’s Law).”

Code of Conduct *

I understand and agree to comply with all terms and conditions as outlined in SOO’s Athlete Code of Conduct.

SOO Rights and Responsibilities *

I understand and agree to comply with all terms and conditions as outlined in SOO’s Athlete Rights and Responsibilities.

Pan-Canadian Confidentiality Policy *

I understand and agree to comply with all terms and conditions as outlined in the Pan-Canadian Confidentiality Policy.

Athlete Name: *

First Name

Last Name

Please check the appropriate box: *

I am the age of majority in my province or territory. I am registering as a Special Olympics athlete and signing this waiver on my own behalf.

I am the parent or legal guardian of this athlete who is under the age of majority or who is not capable of giving legal consent on their own. I am signing this waiver on behalf of the person named above.

If you chose parent or legal guardian, please add your name:

First Name

Last Name

Has the athlete named on this participation waiver: *

(a) ever been convicted of any criminal offence (including as a youth under the Youth Criminal Justice Act); (b) ever been convicted of any offence under the laws of another country that would be a criminal offence in Canada;* (c) ever been charged with a criminal offence (unless those charges ended with acquittal or an absolute discharge)?* [*IMPORTANT: If you answer yes to any of the statements, please contact Farkhanda Shahid at 1-888-333-5515 ext 241 to discuss the individual situation after you sign this form. An individual’s participation will depend on the specific terms of the case.]

No

Yes

Media Opt Out - Athlete

I DO allow Special Olympics to use my picture, words or voice in promotional media.

I DO NOT want Special Olympics to use my picture, words or voice in promotional media.

Media Opt Out - Parent/Guardian

I DO allow Special Olympics to use their picture, words or voice in promotional media.

I DO NOT want Special Olympics to use their picture, words or voice in promotional media.

Media Opt Out Date: *

MM

DD

YYYY

Part 4: Waiver Signature - Please check the APPROPRIATE box and date/sign below: *

This is a legal document and by signing it you are giving up any right you have to make any claims against Special Olympics. You are also acknowledging that you will abide by all of the Organization’s policies and procedures as posted on their website. If you are signing as a guardian for someone else, you are giving up that person’s right to make any claims against Special Olympics. You are also acknowledging that the athlete/volunteer will abide by all of the Organization’s policies and procedures. Please check the appropriate box and sign below.

I am an athlete and I confirm that I understand and agree to the terms and conditions in this Participation Waiver.

I am a parent or guardian providing consent on behalf of the athlete or volunteer named on this participation waiver. I confirm that I understand and have explained the terms and conditions in this form to the athlete/volunteer and agree on their behalf to the conditions stated above. I also confirm that I have legal authority to sign this document on behalf of the person listed on this form. I understand that Special Olympics is relying on my statement to be true that I have the legal authority as guardian or parent, and I agree to provide the organization with any document to confirm this authority if they request it. I also agree to indemnify and protect the organization from any harm or cost if I have signed this Participation Waiver form without legal authority to do so.

Waiver Date: *

MM

DD

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