21.07.2013 Views

BADMINTON Special Olympics Sports Skills Program

BADMINTON Special Olympics Sports Skills Program

BADMINTON Special Olympics Sports Skills Program

SHOW MORE
SHOW LESS

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

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!