Athlete Registration and Medical Forms
  1. Athlete Registration
  2. Emergency and Medical Contacts
  3. Sport Interest
  4. Current Health Status
  5. Family Health History
  6. Past Diagnosis
  7. Neurological Symptoms
  8. Current Medications
  9. Sign & Submit
Athlete Registration
* indicates required
Are you a new athlete to Special Olympics or re-registering?
Athlete Information
Gender *
Language (select all that apply)
Does the athlete have the capacity to consent to medical treatment on his or her own behalf? (e.g. is the athlete their own guardian) *
Parent & Guardian
Required if minor or otherwise has a legal guardian.
Same contact information as athlete?
Emergency and Medical Contacts
* indicates required
Is emergency contact same as parent or guardian?
Sport Interest
* indicates required
Has a doctor ever limited the athlete's participation in sports? *
Current Health Status
* indicates required
Does the athlete have:
Allergies & Dietary Restrictions
Is the athlete allergic to any of the following:
Latex *
Medications *
If yes, please specify:
Insect Bites or Stings *
If yes, please specify:
Food *
If yes, please specify:
Assisted Devices
Does the athlete use: (select all that apply)
Surgeries, Infections, Vaccines
Does the athlete currently have any chronic or acute infections? *
Has the athlete ever had an abnormal Electrocardiogram (EKG) or Echocardiogram (Echo)? *
Has the athlete had a Tetanus vaccine in the past 7 years?
Epilepsy and/or Seizure History
Has the athlete ever been diagnosed with or experienced:
Epilepsy or any other type of seizure disorder *
If yes, had seizure during the past year?
If yes, list seizure type
Mental Health
Has the athlete been diagnosed with or experienced:
Self-Injurious behavior during the past yet? *
Aggressive behavior during the past year? *
Depression (diagnosed) *
Anxiety (diagnosed) *
Family Health History
* indicates required
Has any relative died of a heart problem before of age 50?
Has any family member or relative died while exercising?
Past Diagnosis
* indicates required
Has the athlete ever been diagnosed with or experienced any of the following conditions:
Loss of Consciousness *
Dizziness during or after exercise *
Headache during or after exercise *
Chest Pain during or after exercise *
Shortness of breath during or after exercise *
Irregular, racing or skipped heart beats *
Congenital Heart Defect *
Heart Attack *
Cardiomyopathy *
Heart Valve Disease *
Heart Murmur *
Endocarditis *
High Blood Pressure *
High Cholesterol *
Vision Impairment *
Hearing Impairment *
Enlarged Spleen *
Single Kidney *
Osteoporosis *
Osteopenia *
Sickle Cell Disease *
Sickle Cell Trait *
Easy Bleeding *
Stroke/TIA *
Concussions *
Asthma *
Diabetes *
Hepatitis *
Urinary Discomfort *
Spina Bifida *
Arthritis *
Heat Illness *
Broken Bones *
Dislocated Joints *
Neurological Symptoms
* indicates required
Has the athlete ever been diagnosed with or experienced any of the following conditions:
Difficulty controlling bowels or bladder *
If yes, is this new or worse in the past 3 years? *
Numbness of tingling in legs, arms, hands or feet *
If yes, is this new or worse in the past 3 years? *
Weakness in legs, arms, hands, or feet *
If yes, is this new or worse in the past 3 years? *
Burner, stinger, pinched nerve or pain in the neck, back, shoulders, arms, hands, buttocks, legs, or feet *
If yes, is this new or worse in the past 3 years? *
Head Tilt *
If yes, is this new or worse in the past 3 years? *
Spasticity *
If yes, is this new or worse in the past 3 years? *
Paralysis *
If yes, is this new or worse in the past 3 years? *
Current Medications
* indicates required
Please list any medication, vitamins or dietary supplements below (includes inhalers, birth control or hormone therapy)
Is the athlete able to administer his or her own medications? *
Submit & Sign -- DO NOT CLOSE BROWSER UNTIL SIGNED ON NEXT PAGE
* indicates required
I consent to my (or my athlete's) personal information being sent to the email address listed above, Special Olympics International and my local Special Olympics Program by email. *

When you submit your information on this online form you will be REQUIRED TO SIGN ON THE NEXT PAGE. If you do not consent to your information being sent electronically, please visit your local Special Olympics Program’s website for instructions on other ways to submit your registration forms.