Applicants 17 Years and Under Must Complete This Section

Section 5 must17 years undercompletesectionApplicants andthis Section 4 Organization/Institution: Signed: inSpecialOlympics. orotherswho participate athletes Olympics poseanyunduerisktoSpecial tobelieveApplicant would thatwould causeme 4)Idonotpossessany information and of SpecialOlympics, tovolunteeronbehalf shouldnotbepermitted of anyreasonthatApplicant of Applicant;3)Iamnotaware relative guardianor ageandamnotalegal 2)Iam atleast18years of orprofessional capacity; thisapplicantIneitherapersonal 1) Iknow below,Iconfirm thefollowing:By signing Reference #2 Organization/Institution: inSpecialOlympics. orotherswho participate athletes Olympics poseanyunduerisktoSpecial tobelieveApplicantwould thatwould causeme 4)Idonotpossessany information and of SpecialOlympics, tovolunteeronbehalf shouldnot bepermitted of anyreasonthatApplicant of Applicant;3)Iamnotaware relative guardianor ageandamnotalegal 2)Iam at least18years of orprofessional capacity; thisapplicantIneitherapersonal 1) Iknow below,Iconfirm thefollowing:By signing Reference #1 on date.this Through signature form,my I agreeing the release am onto myabove own provisions behalf. and I readhave understand fullythe of above provisions therelease.application This remain effect shall infromthree for years signature the claim. eachofharmless Releasesfrom the litigation any expenses,fees,attorney liability, orloss, damagecost a may of which as incur result such IndemnityRisk, Agreement”, and of I,anyone onor mymakesbehalf, a ofany claim againstReleases, the indemnify,I save,andwill hold a may of as incur result Unifiedparticipation in Sports®events and further thisagree that “Releasedespite Waiverif, of and AssumptionLiability, activity the fromplacetakes and liability all (other losses, claims thethan that accidentof demands,medical benefit), or costs,damages that I other employees, Unified and Sports®participants, and sponsors, advertisers, and owners lessors if ofapplicable, any and whichpremises on I notrelease, indemnify, covenantsue, harmless to and hold Special administrators, Olympics,its agents, directors, officers, volunteers, necessary toare protect well-being,including, health my and if hospitalization.necessary, my own make arrangements treatmentfor, that because of I authorize injuries,Southmy Special whatever Olympics Dakotato take measures duringmyparticipationIfin Olympics activitiesSpecial I emergencytreatmentshould needmedical am and giveable I notto myconsent for, or at timethat anythat ifthatI feel event the conditions unsafe, are discontinueI will participation immediately. takesevent allplace. I accept and fully andassume responsibilitysuch risks allfor losses, and/orin costs, acknowledge damages participation. I injurywhichmaybodily becaused my own by actionsor by inactions,actions of the othersparticipatingin conditionsevent,theor which by in the health,good in in physical and proper conditionto Unified inparticipate Sports®events. I understandfullythe involves event of risks serious consideration In of participatingSpecial in Olympics IthatUnified representSports®, I understandthe of natureevent that the and I qualified,am PartnerUnified-ReleaseandLiability, of Assumption Waiver Indemnity and Risk, of Agreement     PLEASE READ Signed: Date:

I affirm I have completed the on-line ProtectiveBehaviorstrainingfoundat I affirmhavecompletedtheon-line trueandcomplete. informationandthattheIhavegivenis I affirmhavereadtheabove Date: promote activities Specialpromote of OlympicsDakota. South Special I Olympics Dakotapermissiongrant Southuse to my wordslikeness, television, voice inand or any inradio, film, to form eithercause volunteerwithout theby or Special Olympics Dakota.South between OlympicsThe relationship Southvolunteers Special and Dakota mayis an will” arrangement, “at beand terminated it at time any informationthe insaid confidence; strictest the In of course Special forvolunteering Olympics Dakota,be dealingSouth I may with othersconcerning actsuitability as my Special to a Olympics Dakotavolunteer;South IhaveprovidedThe information that andmay permission be I verified, Specialgive to OlympicsDakota South make to inquiry of

BEFORE SIGNING. I understand that: BEFORESIGNING.Iunderstand Your reference: 1. Cannot be your legal guardian 2. Cannot be related 3. Must be atleast18years old berelated 3. Mustbe legalguardian2.Cannot 1.Cannotbeyour Your reference: atleast18years old berelated3.Must legalguardian2.Cannot 1.Cannotbeyour Your reference:

Applicant SignatureorParent/Guardian Applicant

Relationship toApplicant: Relationship toApplicant: Printed Name: Printed Printed Name: Printed

www.sosd.org confidential information and keep I agree to . Date: