BADMINTON Special Olympics Sports Skills Program
BADMINTON Special Olympics Sports Skills Program
BADMINTON Special Olympics Sports Skills Program
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Application for Participation in <strong>Special</strong> <strong>Olympics</strong> continued<br />
Medications<br />
Medication Name _______________________ Amount _______ Time Taken ____ Date Prescribed _____<br />
Allergies to Medication _____________________________________________________________________<br />
Immunizations<br />
Tetanus YES NO<br />
Date of last tetanus shot ______<br />
Polio YES NO<br />
Signature of Person Completing Health Information<br />
(Parent, Guardian, Adult Athlete)<br />
___________________________________________________ Date ___/___/___<br />
Any significant change in the athlete’s health should be reviewed by a physician before further participation.<br />
Medical Certification<br />
NOTICE TO PHYSICIAN: If the athlete has Down syndrome, <strong>Special</strong> <strong>Olympics</strong> requires that the athlete have a full radiological<br />
examination for the absence of Atlanto-axial Instability before he or she may participate in sports or events, which, by<br />
their nature, may result in hyper-extension, radial flexion, or direct pressure on the neck or upper spine. The sports and events<br />
for which such a radiological examination is required are: equestrian sports, gymnastics, diving, pentathlon, butterfly stroke,<br />
diving starts in swimming, high jump, Alpine skiing, and football (soccer).<br />
CHECK ___ I have reviewed the above health information on and examined the athlete named in the application, and certify<br />
there is no medical evidence to me that would preclude the athlete’s participation in <strong>Special</strong> <strong>Olympics</strong>.<br />
This certification is valid up to three years.<br />
Restrictions ______________________________________________________________________________<br />
SIGNATURE _____________________________________________________________________________<br />
Physician’s Name __________________________________________________________________________<br />
Address _________________________________________________________________________________<br />
Phone Number ____________________________________________________________________________<br />
6 8