ATHLETE APPLICATION FOR PARTICIPATON
OVERVIEW
- Every athlete must have a complete medical form on file prior to the start of training for a Special Olympics Event.
- Medicals are kept on file with NCSO and information is also entered into a statewide database. If medicals are not entered or complete, the athlete is not approved for participation by Special Olympics PA.
- All physicals must be completed on the PA Special Olympic medical form. No other medical form will be accepted.
- Arrange for your family doctor or frequently seen physician to review your athlete's medical history and complete the Physical Examination section. Many physicians and Public Health Agencies will perform the necessary examination for free or at a reduced cost when asked to do so for Special Olympics.
- Medicals are good for three years.
FOR PARENTS/GUARDIANS
- All contact information/ phone numbers must be clearly and accurately written.
- Upon completion of the application and medical form, return it to the local program representative or your child's teacher who will arrange for your athlete to begin training in the sport of his/her choice.
FOR TEACHERS
- Medicals are good for three years and should be given to a new teacher or placement along with other records.
- Teachers must carry a current copy of each student‘s medical form to all events.
- Prior to submitting the medical form, please check to make sure that each medical contains the following required information.
- Whenever possible, submit the original medical form to Amanda Sechrist/ Colonial Intermediate Unit 20. It helps me if physicals are not stapled. Please write your name and the IU program (AS, MDS, etc.) or school district (Northampton, Bethlehem, etc.) on the upper right hand corner of the medical. Send in only new or updated physicals.
- Submit each new physical as soon as it is received. Updated physicals are due to the IU office at least 4 weeks before an event and, when possible, no later than April 1st. Physicals are to be handed in at an event as a last resort.
- Please contact Linda Lechner if there are any questions, to confirm the status of a student in your class or if an address, phone number or class placement changes for any of your students.
HOW TO
- Upper left corner: sex, birthdate (SS NUMBER NO LONGER REQUIRED)
- Center top: Fill in school information and mark as district or IU.
- Athlete/Parent Contact Information: must be complete and legible.
- Emergency Information: Include emergency contact information, if available. It is required if the parent contact section is not filled out.
- Health and Accident Insurance: This section is not required, but please complete if information is available.
- Health information: All questions must be circled with a yes or no.
- Medications: All medications should be listed.
- Immunizations: This section is not required, but please complete if information is available.
- Medical Certification: This section must include the health care provider’s name, address, phone number, date of physical and a signature from an MD, DO, CRNP, FNPs, or PA.
- Release: The release on the back of the form must be signed by a parent/legal guardian or an adult athlete with witness signature.
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| Printable Medical Instructions.pdf |
| Medical Form - Eniglish.pdf |
| Medical Form - Spanish.pdf |
