Healthy Athletes Consent Form

Special Olympics offers certain non-invasive health care services to athletes at local, provincial/territorial, national and World Games venues through the Healthy Athletes Program. These services may include individual screening assessments of health status and healthcare needs, provision of health education, routine preventative services (e.g. protective mouth guards), educational services and, in the case of vision and hearing deficit, provision of needed eye wear (glasses, swim goggles, protective eye wear) and hearing aids. Athletes are informed as to their health status and advised of the need for follow-up care. In addition, information collected at the time services are provided has been invaluable for developing policies, securing resources, and implementing programs to better meet the health needs of athletes.

I understand that by signing below I consent to participate in the Special Olympics Healthy Athletes program that provides individual screening assessments of health status and health care needs in the areas of: vision; oral health, hearing; physical therapy; and a variety of health promotion areas (height, weight, sun protection, etc.). I understand there is no obligation for me to participate in the Healthy Athletes Program should I decide not to participate. Provision of these healthy services is not intended as a substitute for regular care. I also understand that I should seek my own independent medical advice and assistance irrespective of these provisions responsible for my health. I understand that information that is gathered as part of the screening process may be used in group form (anonymously) to assess and communicate the overall health needs of athletes and to develop programs to address those needs.

Please contact Brock Reissner with any questions or concerns: brockr@specialolympicsontario.com 1-888-333-5515 extension 249