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2019-20 YOUNG ATHLETES SCHOOL REGISTRATION FORM PROGRAM/SCHOOL CONTACT INFORMATION Program/School Name: __________________________________________________________________________ Program/School Address: ________________________________________________________________________ Program/School Phone: ____________________________ Program/School Fax: __________________________ Educational Level (i.e. Preschool, Elementary School, Head Start, etc.): _________________________________ Program/School Administrator Name: _____________________________________________________________ Program/School Liaison Contact Name: ____________________________________________________________ Program/School Liaison Contact Phone/Cell: _______________________________________________________ Program/School Liaison Contact Email: ____________________________________________________________ I consent to receive the Special Olympics Arizona e-newsletter and event information WAIVER OF LIABILITY On behalf of the Program/School named above, I agree that the Program/School assumes all liability, including proper insurance coverage and full responsibility for any risk of loss, property damage, or personal injury in connection with Special Olympics Young Athletes activities occurring under the school’s supervision. I certify that I understand the expectations of the program and agree to commit to the Young Athletes Program for the school year identified above. __________________________________________________ ________________________________________ ___________________ Program/School Administrator Signature Print Name Date __________________________________________________ ________________________________________ ___________________ Program/School Liaison Signature Print Name Date For questions, please contact Special Olympics Arizona: Shae Knowlton Unified Champion Schools Coordinator Shae@SpecialOlympicsArizona.org 480.310.6649