Athlete Registration Form
  • Image field 379

  • As of January 1st, 2025, Special Olympics Massachusetts is no longer requiring a doctor signature to participate as an athlete. This is the new online athlete registration form. Please complete all 4 pages of this form. If you have any questions, contact Ops@SpecialOlympicsMA.org or refer to the Frequently Asked Questions resource.

  • Athlete Contact Information

  • Athlete Date of Birth*
     / /
  • Format: (000) 000-0000.
  • Has athlete participated at a Special Olympics Schools Event? (Optional)
  • Language(s) Spoken (optional)
  • Race / Ethnicity (optional)
  • Image field 380

  • Parent/Legal Guardian and Emergency Contact Information

  • Parent/Legal Guardian

  • Format: (000) 000-0000.

  • Emergency Contact

    Please provide an individual who is readily available and can be contacted in an emergency
  • Format: (000) 000-0000.
  • Image field 381

  • Medical Information

    Please expand each section to complete the questions.

  • Medical Insurance Information

    Kept on file in case of medical emergency
    • Associated Conditions 
    • Check all that apply:*
    • Devices and Accommodations 
    • Mobility*
    • Lifestyle Aids*
    • Communications*
    • Medical Devices*
    • Do you have a specific dietary requirement and/or allergies?*
    • Do you use other assistive devices?*
    • General Health Questions 
    • Do you have a heart condition?*
    • Do you have asthma?*
    • Heart Condition for SF
    • Do you have a hearing impairment?*
    • Do you have diabetes that requires you to take insulin?*
    • Asthma for SF
    • Diabetes for SF
    • Do you have a vision impairment?*
    • Do you have a bleeding disorder?*
    • Vision impairment for SF
    • Hearing impairment for SF
    • Bleeding Disorder for SF
    • Has a doctor ever limited your participation in sports?*
    • Do you have epilepsy or any type of seizure disorder?*
    • Limitation in sports for SF
    • Epilepsy for SF
    • Do you have sickle cell disease?*
    • Sickle cell for SF
    • Have you ever had a concussion?*
    • Concussion to Salesforce True false
    • Date of last concussion:*
       - -
    • Do you have behavioral, mental health, and/or sensory conditions?*
    • Do you have severe allergies that requires the use of an EpiPen?*
    • If yes, please specify if it is to any of the following:*
    • EpiPen for Salesforce True False
    • Medication and Treatment 
    • Are you taking any prescription or over-the-counter medications or treatments? (Including birth control pills, insulin, multivitamins, allergy shots or pills, EpiPen, asthma inhalers, epilepsy medication, anti-inflammatory medication, supplements of any kind. etc.)*
  • Image field 382

  • Participant Releases

  • 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:
  • Religious Objection for SF
  • Blood Transfusion for SF

  • I am a Special Olympics athlete with capacity to sign documents on my own behalf, or I am a parent/guardian submitting on behalf of an athlete, and agree to the following:


    1. No Consent to Emergency Medical Care . I understand that the standard Special Olympics registration form requires athletes, or their parents or guardians, to consent to the athlete receiving medical care if needed in an emergency. Based on religious beliefs or other reasons, I am not consenting to emergency medical care and/or blood transfusions as answered in the previous part of the form.


    2. Printed Instructions . I agree to carry printed instructions describing my religious or other objections to medical treatment and how I would like the person accompanying me to respond if I become ill or injured and cannot speak for myself. I agree to carry these printed instructions with me at all times during my participation in any Special Olympics activity, including during meals, at overnight accommodations, at training sessions and competitions, and during travel to and from Special Olympics activities.


    3. Accompanying a friend or family member . I understand that I must be accompanied by an adult friend or family member to all Special Olympics MA practices, competitions, and events, in order for that person to take personal responsibility for me during a medical emergency when I may be unable to speak for myself. I also understand I will be ineligible to travel overnight to Special Olympics MA events unless accompanied by a parent/guardian who is also a registered Special Olympics MA volunteer.


    4. Emergency Medical Care If Athlete Is Unaccompanied . I understand that if I do not have printed instructions with me, or if an accompanying adult is not present and actively taking personal responsibility for me during a medical emergency in which I am unable to speak for myself, Special Olympics may seek emergency medical care for me as recommended by the medical professionals responding to the emergency.


    Release of Liability . I release Special Olympics, its employees, and its volunteers from all claims that may arise from their taking or failing to take steps to provide me with emergency medical care. I am agreeing to this release because I have knowingly and voluntarily refused to give Special Olympics permission to take emergency care, and I am expressly denying consent to emergency medical care for religious or other reasons. For this form, “Special Olympics” means all Special Olympics organizations.

  • Signature - I am signing as:*
  • Clear

  • Athlete Signature

  • Parent/Guardian Signature

  • Newsletter True or False
  • Date
     - -
  • Date plus 1 year
     - -
  • Should be Empty: