Annual KCSO Registration Please enable JavaScript in your browser to complete this form.Is Athlete new to KCSO? *YesNoLayoutAthlete Given Name *FirstLastNickname - if any:Athlete Birthdate *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920AddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLayout#1 Parent/Guardian Name *FirstLast#1 Athlete Parent/Guardian Email Address *#1 Parent/Guardian Phone Number *Layout#2 Parent/Guardian NameFirstLast#2 Athlete Parent/Guardian Email Address#2 Parent/Guardian Phone Number LayoutEmergnecy Contact *FirstLastEmergency Contact Phone Number *Medical InformationLayoutDoes your athlete take medication? If so, please list each medication, dosage and frequency: If none - indicate - None *Does athlete have allergies? If so - please list to what and what happens when exposed: If none - indicate - None: *LayoutDoes Athlete have seizures: *YesNoIf yes- please indicate date of last seizure, if there are any triggers/auras prior to onset:If yes to seizure's, please indicate emergent first aid needed when a seizure occurs - or do you have a seizure action plan:Uniform SizingLayoutUniform Size: T-shirt: *Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult 2XAdult 3XAdult 4 XUniform Size: Sweatshirt/Fleece *Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult 2XAdult 3XAdult 4 XUniform Size: Pants/Shorts *Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult 2XAdult 3XAdult 4 XUniform Size: Jacket (Indicate Size larger) *Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult 2XAdult 3XAdult 4 XAcknowledgements:Does Athlete need assistance with registration fees: *YesNoLayoutMedical Applications: I understand that my athletes medical application with Special Olympics Illinois must be current by the first practice of any event they will not be able to participate in that event. *I acceptIllness: I understand that if my athlete or any family member attending events are ill - they will not attend any practice, event or competition. *I acceptPractices: I understand that if my athlete does not attend at least 80% of practices, they may not be able to compete in any given sport. *I acceptRegistration Fees: 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 until paid. *I acceptI, the below signed, agree to abide by all the rules and expectations of each sport. I will also support my athlete by encouraging them, agreeing and abiding by the Special Olympic Athlete oath and code of conduct, represent KCSO 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 KCSO Executive Board. Typing your name here serves as an on-line signature.Name *FirstLastPayment:Annual Registration Fee Payment *Annual Registration Fee - $ 40.00Pay by Check/Cash at 1st Practice - $ 0.00Scholarship - $ 0.00Please make sure to submit your payment to any board member. Total$ 0.00Enter Credit Card *CardName on CardEmailPymnt *Email of Credit Card HolderSubmit39450