Religious Objections Form

This is optional and only to be complete if there are religious objections regarding medical treatment.
  • On the attached official Special Olympics Release form, I have crossed out and rejected, on behalf of (name of athlete, listed below), the provision that authorizes Special Olympics to make arrangements for emergency medical treatment for the athlete if the athlete is injured and his/her parent are unable to consent to that treatment. I am withholding this permission on behalf of the athlete on religious grounds.
  • However, on behalf of myself and the athlete named in this Application, I do agree to and confirm the following:

    1. I or a designated adult family member agree to be present with the athlete at all times at the site of any Special Olympics training or competitive event in which the athlete participates, including during travel to and from the training or competition, in the dormitories, meal time, and during competition, training and practice sessions, so that I can be readily available to take personal responsibility for the athlete if a medical emergency arises. I understand that if a designated family member is not present at all times, the athlete will not be permitted to participate in that event, and that no exception will be made.2. I also agree on behalf of myself and the athlete to release Special Olympics and its employees and volunteers from any and all claims, demands or liabilities of any kind that may arise outof Special Olympics failure to take measures to provide the athlete with emergency medical treatment during Special Olympics’ events and activities. I am agreeing to this release because I have refused, knowingly and voluntarily, to give Special Olympics permission to take such emergency measures, and I am expressly directly Special Olympics not to do so on religious grounds.
  • 2. I also agree on behalf of myself and the athlete to release Special Olympics and its employees and volunteers from any and all claims, demands or liabilities of any kind that may arise outof Special Olympics failure to take measures to provide the athlete with emergency medical treatment during Special Olympics’ events and activities. I am agreeing to this release because I have refused, knowingly and voluntarily, to give Special Olympics permission to take such emergency measures, and I am expressly directly Special Olympics not to do so on religious grounds.
  • This field is for validation purposes and should be left unchanged.

If you have any questions or comments about the Young Athletes Program, please contact us at YAPhilly@specialolympicspa.org.