Annual KCSO Registration Please enable JavaScript in your browser to complete this form.Is Athlete new to KCSO? *YesNoAthlete Given Name *FirstLastNickname - if any:Athlete Birthdate *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address *Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code#1 Parent/Guardian Name *FirstLast#1 Athlete Parent/Guardian Email Address *#1 Parent/Guardian Phone Number *#2 Parent/Guardian NameFirstLast#2 Athlete Parent/Guardian Email Address#2 Parent/Guardian Phone Number Emergnecy Contact *FirstLastEmergency Contact Phone Number *Medical InformationDoes 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: *Does 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:Are there any behavioral issues that KCSO needs to be aware of? *Acknowledgements:Does Athlete need assistance with registration fees: *YesNoMedical 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 Cash/Check in Person - $0.00Scholarship - $0.00If paying by cash or check, please make sure to submit your payment to any board member or coach at the first practice or social event. Total$0.00Enter Credit Card *CardName on CardEmailPymnt *Email of Credit Card HolderSubmit2312672439