Athlete Interest Form

Please complete and remit this form to indicate interest in participating in Special Olympics programs in Allen County, Indiana. Special Olympics programs are offered to persons 8 years of age or older with intellectual disabilities.
Athlete Information
Athlete Name (First, Last):  
Date of Birth:    
Gender:  
Contact Information
Street Address:
City, State, Zip:  
Daytime Phone:
Evening Phone:
E-Mail:
Contact Person:
Other than athlete
Relationship to Athlete:
Parent, Guardian, etc
Following is a list of potential sports activities to be conducted by Special Olympics in Allen County.
Please indicate any/all sports that may interest this athlete.
Sport Interests
   
Image Verification
Please enter the string shown in the image in the form.
The possible characters are letters from A to Z in capitalized form and the numbers from 0 to 9.