2021-2022 KCSO Annual Athlete Information Form

• Is this athlete new to KCSO?*
  • No
  • Yes
  Please mark “Yes” if it has been more than 2 years since the athlete has participated with KCSO.
• Athlete Given Name*
  First Last
• Nickname - if any
• Athlete Date of Birth*
  Date Format: MM slash DD slash YYYY
• Address*
  Street Address City State ZIP / Postal Code
• Parent/Guardian #1*
• Primary Emergency Number*
  Enter phone number for emergency purposes at events and practices.
• Parent/Guardian #2
• Email for Distribution List*
• Emergency Contact*
  First Last
• Emergency Contact Phone Number*
• Does your athlete have seizures? If "Yes", please answer the questions below:*
  • Yes
  • No
• Date of Last Seizure
• Any triggers/auras prior to onset? Please explain:
• In the event of a seizure, KCSO will follow basic first aid procedures for the care of one. Please indicate any additional steps needed in case of an event:
• Uniform Sizing - T-Shirt*
  • Youth Small
  • Youth Medium
  • Youth Large
  • Adult Small
  • Adult Medium
  • Adult Large
  • Adult XL
  • Adult 2XL
  • Adult 3XL
  • Adult 4XL
• Uniform Sizing - Sweatshirts/Fleece*
  • Youth Small
  • Youth Medium
  • Youth Large
  • Adult Small
  • Adult Medium
  • Adult Large
  • Adult XL
  • Adult 2XL
  • Adult 3XL
  • Adult 4XL
• Uniform Sizing - Pants/Shorts*
  • Youth Small
  • Youth Medium
  • Youth Large
  • Adult Small
  • Adult Medium
  • Adult Large
  • Adult XL
  • Adult 2XL
  • Adult 3XL
  • Adult 4XL
• Uniform Sizing - Jacket - Indicate a size larger*
  • Youth Small
  • Youth Medium
  • Youth Large
  • Adult Small
  • Adult Medium
  • Adult Large
  • Adult XL
  • Adult 2XL
  • Adult 3XL
  • Adult 4XL
• Does your athlete need financial assistance with registration fees?*
  • Yes
  • No
  Please do not indicate "Yes" unless cleared by KCSO Executive Board. If you had financial assistance in the past, you may indicate "Yes"

• Acknowledgements:

• Acknowledgement of Non Payment of Registration Fees:*
  • I accept
  I understand that if I do not pay the registration fees by the first practice of any sport, my athlete will not be able to participate in that event.
• Acknowledgement of Athlete attending 80% of practices*
  • I accept
  I understand that if my athlete does not attend at least 80% of practices - they may not be able to participate in that sport.
• Medical Application Acknowledgement:*
  • I acknowledge
  I acknowledge that I am responsible for making sure that my athletes medical application is current and if not, it is due at the first practice of the sport they are participating in.
• COVID-19 Rules*
  • I acknowlege
  I acknowledge that my athlete will abide by all the COVID -19 protocols that Special Olympics Illinois requires. If they have any COVID-19 symptoms they will not participate and will follow the PPE protocols (face mask, social distancing and hygiene) at all events.
• Parent-Guardian Signature/Parent Guardian Contract*
  First Last
  I the above signed, agree to abide by all the rules and expectations outlined in the KCSO Athlete/Parent-Guardian expectations. I will support my athlete to the best of my ability. I will also support my athlete by encouraging him or her to agree to abide by the Special Olympic Athlete oath and represent KCSO Family and Friends at all practices, competitions, trips and events with a respectful and positive attitude. Noncompliance to this agreement may result in a partial exclusion from practice or competition by the head coach. A total exclusion from one or more sports may occur after a review by the mediation/conduct resolution committee. (typing your name here serves as online signature)