The Athlete Medical and Release Form – a Tutorial Program Year 2017-2018

The Athlete Medical Form Must be completed and approved by the State Office before an athlete begins practice. Special Olympics Wisconsin State Office: 2310 Crossroads Dr., Ste. 1000, Madison, WI 53718. You can also email forms to medicals@specialolympicswisconsin.org – DO NOT FAX. 1st and 2nd page – must be completed by the adult athlete (if they are their own guardian), a parent, guardian or caregiver. 3rd page – must be completed by a healthcare professional. Acceptable healthcare professionals include M.D., D.O., P.A. or N.P. 4th page – only to be used if an athlete is restricted from a sport in which they wish to participate. A current WIAA physical form will be accepted in lieu of the Athlete Medical Form

Athlete Medical Form Errors Physical exam section is blank – we cannot process forms that have notes attached instead of this section being completed. The medical examiner’s signature is missing. The medical examiner’s signature date and/or date of exam is missing. Restrictions or medical examiner’s comments are unclear. The medical was not signed by an M.D., D.O., N.P. or P.A. The form is faxed to the State Office – however, forms that have been faxed back and forth to a doctor’s office but are then mailed or emailed to the State Office ARE acceptable.

Athletes with Down Syndrome Medical Restrictions If, on page 3 of the Athlete Medical Form, the medical examiner indicates the athlete has neurological or physical findings that could be associated with atlantoaxial instability, then the Medical Referral Form (4th page of the Athlete Medical Form) or the AAI Special Release Form must be submitted to allow the athlete to participate in the following sports offered by Special Olympics Wisconsin: alpine skiing, butterfly stroke, diving start, football (soccer) team, football (soccer) skills, gymnastics – artistic, powerlifting (squat lift only), snowboarding. If an athlete needs the AAI Special Release Form, please contact your local program or the State Office.

Medical Deadline Dates February 1 (Indoor Sports Season) – Basketball & Gymnastics April 1 (Summer Games Season) –Athletics (Track & Field), Powerlifting, Soccer & Swimming June 1 (Outdoor Sports Season) – Softball/Teeball, Tennis, Golf & Bocce September 15 – Flag Football October 1 (Fall Sports Season) – Bowling & Volleyball December 1 (Winter Games Season)– Skiing, Snowshoeing, Snowboarding & Unified 3v3 Basketball

New Athletes Who Miss a Medical Deadline Once their Athlete Medical and Release Forms are received by the State Office they may practice for the rest of that sports season but cannot compete in any competitions for that season. The athlete will be eligible for competition beginning with the next sports season.

Current Athletes Who Miss a Medical Deadline If the athlete’s current medical expires after district/regional competition but prior to sectional and/or state competition, they may compete in the district/regional event only. They cannot advance to sectional and/or state competition. If the athlete’s current medical expires after sectional competition but prior to state competition, they may compete in both district/regional and sectional events but cannot advance to state competition.

Final Reminder – Athlete Medical Forms Athlete Medical Forms MUST be correctly completed and postmarked or emailed by the medical deadline date for that sports season. An athlete’s medical is good for three years from the date of exam, however if their current medical expires prior to the end of a sports season, they must have a new medical postmarked or emailed by the season’s medical deadline date if they intend to compete during that sports season. Forms cannot be faxed to the State Office.

The Athlete Release Form Only needs to be completed once unless there is a change in guardianship Will not be processed if any section is crossed out/altered Must be completed and approved by the State Office before a new athlete begins practice Special Olympics Wisconsin State Office: 2310 Crossroads Dr., Ste. 1000, Madison, WI 53718. You can also email forms to medicals@specialolympicswisconsin.org

Highlighted Areas MUST Be Completed OR

The Emergency Medical Care Refusal Form If refusal for emergency medical care and/or blood transfusions is noted on the Athlete Medical Form and/or Athlete Release Form, then the athlete will be restricted from all practices and competitions until the Emergency Medical Care Refusal (EMCR) Form is received. Please contact your local program or the State Office if you are in need of the EMCR Form. Wisconsin law only allows refusal of emergency medical care in a life threatening situation if a DNR or Advanced Directive is presented. While no blood transfusions would ever be administered at any SOWI sanctioned practice or event and such responsibility would be assumed by the treating hospital, the athlete and/or their parent/guardian still must complete the EMCR Form if refusal for blood transfusions is noted on the Athlete Release Form.

Final Reminder – Athlete Release Forms Athlete Release forms MUST be correctly completed and postmarked or emailed by the medical deadline date for that sports season for new athletes or returning athletes without a release form on file. Current athletes do not need to renew their Athlete Release forms, only their Athlete Medical forms. Forms cannot be faxed to the State Office.

Keep Up to Date! Visit our website at http://www.specialolympicswisconsin.org/athlete-medical-info/ to check when an athlete’s medical form expires. This information is updated every Friday afternoon. An athlete’s medical must remain valid through the LAST DAY OF STATE COMPETITION for that sports season. If it does not, the athlete must have their medical renewed and postmarked by the medical deadline date for that sport. NO EXCEPTIONS! If an athlete needs to renew their medical form but their insurance does not yet allow for another physical, the athlete can have the healthcare provider write the date of the last physical exam on the form.

Questions? Samantha Sotelo, Athlete Records Manager (608) 442-5677 ssotelo@specialolympicswisconsin.org