6-1 project unify information workbook 2015-2016
TRANSCRIPT
Special Olympics
Colorado
Unified Schools
6-1
2015-2016
Special Olympics Colorado
Unified Schools
Information Workbook “Youth leaders promoting inclusion, acceptance and social justice”.
6-2
1
® What is Project UNIFY ………. 2
Why should a school become involved………. 3
® Road Map for Project UNIFY ………… 4
Liaison Responsibilities………. 6
Unified Sports®…….. 7
Lettering………. 11
Regional Competitions………. 13
Codes of Conduct………. 14
R-Word………. 16
Fans in the Stands………. 18
® Partners Clubs ………. 20
Get Into It………. 22
Youth Summit………. 23
Resources………. 24
School Agreement………. 25
Athlete Medical………. 26
Volunteer Application………. 30
Table of Contents
6-3
2
Road Map for Project UNI What is Special Olympics Project UNIFY®? Special Olympics Project UNIFY® is a US national project, funded by the US Department of Education that is implemented within elementary, middle and high schools across the nation. Its goal is to activate youth around the country in an effort to promote the importance of inclusive school activities. Special Olympics Project UNIFY is designed to change perspectives, enhance relationships, and boost acceptance among students with and without intellectual disabilities by utilizing the existing sports and education related initiatives of Special Olympics in combination with programs within the school communities. Each school committed to taking part in Special Olympics Project UNIFY initiatives is committed to ensure Special Olympics Unified Sports, School community collaborations and Youth Leadership are achieved within their school. Why should schools get involved? Special Olympics Project UNIFY provides a framework, philosophy and set of practices that engage all students in activities that improve achievement and lead to lifelong success. Special Olympics Project UNIFY is proven to enhance school climate. Clear and Defined Characteristics of Project UNIFY®:
1. School-Community Collaborations, R-word/Rallies 2. Inclusive Programming/Unified Sports Options 3. Inclusive Youth Leadership/Youth Activation
Special Olympic Project UNIFY® Initiatives Schools are encouraged to take part in: -R-Word -Fans in the Stands -Unified Field Day/Unified Clinic
-Partners Clubs -Get Into It Curriculum -Unified Sports®
-Youth Summits -Movies that Move -Unified Sports Player Development
-Global Messenger Trainings -Unified Recreation -Red Shirt Rookies/Young Athletes Special Olympics Project UNIFY® in Colorado for 2014-2015:
158 Project UNIFY Schools
24 districts involved with Project UNIFY
4th Annual Project UNIFY Youth Activation Summit
6th Year of Statewide Youth Activation Committee
131 Unified Sports® Teams
Special Olympics Colorado is in its 7th year of Project UNIFY.
Contact Information: -Chaka Sutton, Executive Vice President of Project UNIFY & Unified Sports-Unified Sports [email protected] | 720.359.3102 -Allo Perry, Project UNIFY Sports Manager- Unified Sports/Red Shirt Rookies [email protected] | 720.359.3106 -Mandi DeWitt, Project UNIFY Youth Initiatives Manager- Youth Leadership/Whole School Awareness/ Young Athletes [email protected] | 720.359.3117
What is Project UNIFY®?
6-4
3
All Project UNIFY strategies focus on creating and sustaining a positive school climate that values and
manifests appropriate and effective engagement leading to inclusion, acceptance, respect and human
dignity. These strategies include students engaged in Unified Sports®, youth leadership, school
community collaborations, service-learning opportunities, improving classroom practice, professional
development and creating and sustaining relationships between students with and without intellectual
disabilities.
At the local level, Project UNIFY leaders and staff can demonstrate to district and school leaders that
Project UNIFY not only engages students with and without intellectual disabilities in sports and
competition but that such engagement will only be sustained through school climate that nurtures
development, learning and achievement. Furthermore, such a school climate engages all stakeholders in
more authentic ways providing many benefits to the district and school.
These actions will advance quality school climates that not only support Project UNIFY characteristics
but also provide teaching, learning, serving and interactive environments for students, teachers,
administrators, parents and community members to feel connected, safe and successful.
Special Olympics Project UNIFY takes us:
-From include to UNIFY
-From special education students to all students
-From adult-led to student-led
-From sport opportunities to sports as a catalyst for social inclusion and attitude change
Outcomes of Project UNIFY -Students without disabilities hold more positive attitudes toward their peers with intellectual disabilities. (Measure: attitude and behavior change) -School communities of acceptance where students with intellectual disabilities feel welcome and are routinely included in, and feel a part of, all school activities, opportunities and functions; (Measure: perceptions of school climate) -Perception of Special Olympics as a school and community partner that offers programming that benefits all students. (Measure: perceptions of Special Olympics by general educators and school administrators) -More students with and without ID playing sports together (Measures: increased Unified Sports® Teams and programs, more 2-7 year-olds participating in Young Athletes, and more Young Athlete programs)
Why should a school become involved with PU?
UNIFY®?
6-5
4
Schools participating in Project UNIFY are required to fulfill a number of tasks throughout their project time
frame. The requirements are listed below and are specific to Elementary Schools and Middle/High Schools.
Elementary Schools should:
1. Appoint a school based liaison to work with Special Olympics Colorado Staff.
2. Begin a Unified Sports Option including Red Shirt Rookies, a Unified Sports® program, or a traditional Special
Olympics sports program that must include Unified Experiences. A general education class or student volunteers
should be included in practices or training sessions and can serve as peer coaches, additional volunteers, unified
partners, or “buddies”. Examples Include but are not limited to:
a. Unified Sports® Team that practices and competes
b. Red Shirt Rookies before/after school program
c. Unified Recreation, Unified Gym Class, Unified Field Day, Unified Clinic
3. Teach at least one lesson from the Special Olympics ‘Get Into It’ service learning guide to a general education
class. Each of the four lessons can be downloaded, free of charge, through the Special Olympics website. You may
also teach a lesson from the GIIT Active or the Movies that Move DVD.
4. Implement at least one school-wide activity that promotes End the R-Word campaigns.
5. Meet with Special Olympics Colorado staff for face-to-face meetings to discuss your specific Project UNIFY
program.
6. Submit a monthly Unified update to SOCO. These “reports” will give Special Olympics Colorado staff a better
look into your program and the activities you’ve done throughout the month. This will be a very simple
requirement and helps SOCO keep track of what is going on within your school.
7. Finally, you may be asked to complete an online survey, provided by the University of Massachusetts, towards
the end of the school year which serves as an evaluation of the grant project. This survey will be completed by all
schools, across the country to gather statistics and results for nationwide Project UNIFY movements.
8. Other suggestions that are encouraged from every school involved in Project UNIFY are:
a. Sharing of photos, videos, and stories of their activities and events using web-based resources, such as the
Special Olympics Fan Community Site.
b. Development of a School Coordinating Team/Leadership Team comprised of at least one special education
teacher, one general education teacher, one athlete, and one partner with some involvement from a school
administrator. These Teams will work together and come up with ideas for the grant project and how they can
impact their school climate.
c. Creation of a Fan Club/Partners Club at your school. These clubs will be comprised of students and athletes that
want to help in the activities being promoted through your Project UNIFY program and promote the program
through special projects or activities. Partners Clubs are an ideal group to take on the duties of an R-Word
Campaign.
Road Map for Project UNIFY®
6-6
5
Middle and High Schools should:
1. Begin a Unified Sports Option. This is a Unified program or Special Olympics sports program that must include
Unified experiences. A general education class or group of student volunteers should be included in any practices
or training sessions that are being held and can serve as unified partner and/or peer coaches. (Unified Sports
Team, Unified Player Development, Unified Recreation)
2. You are required to teach or incorporate at least one lesson from the Special Olympics ‘Get Into It’ curriculum
to a general education class. Each of the four lessons can be downloaded, free of charge, through the Special
Olympics website. You may also teach a lesson from the GIIT Active or the Movies that Move DVD.
3. You must implement at least one school-wide activity that promotes Be a fan and/or R-Word campaign.
4. Meet with Special Olympics staff for face to face meetings to discuss your specific Project UNIFY Program.
5. Submit a monthly unified update to SOCO. These “reports” will give Special Olympics staff a better look into
your program and what activities you’ve participated in through the previous month. This will be a very simple
requirement and is just a few sentence update on any inclusive initiatives taking place at your school.
6. Your school should also attempt to create and implement a Fan Club/Partners Club for Project UNIFY. These
clubs will be comprised of students and athletes that want to help in the activities being promoted through your
Project UNIFY program.
7. Organize some sort of culminating activity. This activity can be classroom-based, school-based or include
multiple schools in your district/region. The activity could be a competition or could be your school-wide activity.
Finally, you will be asked to complete an online survey, provided by the University of Massachusetts, towards the
end of the school year which serves as an evaluation of the grant project. This survey will be completed by all
schools, across the country, to gather statistics and results for the nationwide Project UNIFY movement.
8. Other suggestions that are encouraged from every school involved in Project UNIFY are:
a. Participation in the Project UNIFY Youth Leadership Summit and/or Global Messenger Training.
b. Sharing of photos, videos, and stories of their activities and event using web-based resources, such as
the Special Olympics Fan Community site or SOCO Project UNIFY Facebook Page.
c. SOCO also hosts a core of activities and fundraisers including the Polar Plunge that could be fun for
schools to attend as a group.
Below you will find a list of different Initiatives Project UNIFY Schools can take part in:
-Unified Sports Options
-R-Word Campaigns
-Youth Leadership Summits
-Fans in the Stands
-Partners Clubs
6-7
6
-Rallies
Each Project UNIFY School must appoint a School Liaison to work with Special Olympics Colorado staff members.
This person will be responsible for communicating with PU Staff about inclusive initiatives taking place at your
school.
Who should be your school liaison?
A teacher, Para, coach or anyone who works in your school and is passionate about working with students with
special needs and is supportive of everything Project UNIFY embodies.
How much time will the school liaison need to commit to Project UNIFY?
The time commitment will vary, as it depends how many people you have supporting you with Project UNIFY.
Most schools have Partners Clubs or Student Leadership groups run their R-Word campaigns, Unified Sports® and
other PU Initiatives. You can dedicate as much or as little time as you wish to working on Project UNIFY. The more
support you have from staff and students the less work the school liaison will have.
Who should the school liaison communicate with?
For Unified Sports Questions/Communications: For Youth Leadership/Whole School Awareness:
Allo Perry Mandi DeWitt
Project UNIFY Sports Manager PU Youth Initiatives Manager
720.359.3106 720.359.3117
[email protected] [email protected]
What are the school Liaison responsibilities?
Send brief updates on inclusive initiatives taking place at your school. Monthly reporting is important for
measuring the impact of Project UNIFY in your school and so SOCO can report on your schools progress!
Pick a date (or two, or three!) for when your school will hold their R-Word Campaign.
Order R-Word Campaign materials for your school (February).
If your school is partaking in Unified Sports® be sure all athletes, Unified Partners and Coaches have
turned in required paperwork. Update Allo with practice and competition schedules.
Let Allo know if your school would like a training set up to educate coaches, Unified Teams or staff on
Project UNIFY and Unified Sports.
Make sure all initiatives of Project UNIFY are taking place at your school throughout the year. Act as the
school messenger between SOCO and the students at your school.
Communicate preferred meeting dates to PU Sports Manager.
Distribute SOCO Project UNIFY Youth Leadership Summit registration forms to students as well as flyers
about other SOCO events such as the Polar Plunge.
Be sure to let SOCO Staff know if they can be of assistance or guidance in any way possible!
Project UNIFY® School Liaison Responsibilities
6-8
7
Unified Sports® was launched throughout the United States in 1989 after two years of field testing.
Unified Sports® is now a global program. Special Olympics Unified Sports® is a program that combines Special
Olympics Athletes and athletes without intellectual disabilities (partners) on the same sports team. Unified
Sports® enables athletes to develop friendships and a better understanding of each other’s capabilities through
a spirit of equality and team unity.
Unified Sports® is one of Project UNIFY’s key characteristics. Project UNIFY is an education based project,
funded by the US Department of Education that uses the sports and education programs of Special Olympics to
activate young people across the US. Besides Unified Sports®, other initiatives of Project UNIFY include Youth
Leadership and School/Community Collaborations. Once your school becomes a ‘Project UNIFY School’ Special
Olympics Colorado can then endorse your school and provide your school funding for uniforms, equipment,
partners clubs and R-Word campaign events.
Unified Sports® is a unique and important program because it:
-Integrates athletes with and without intellectual disabilities in a setting where all athletes are challenged to
improve their skills.
-Provides valuable sports opportunities to individuals with intellectual disabilities who are not presently involved
with Special Olympics, especially those with mild intellectual disabilities and those in communities where there
are not enough Special Olympics Athletes to create teams.
-Prepares athletes with higher level skills for participation in school or community sports.
-Increases public awareness of the spirit and skills of individuals with intellectual disabilities.
-Enables families of Special Olympics Athletes to participate as team members or coaches of Unified Sports®
Teams.
Goals of Special Olympics Unified Sports®
-Sport skill development- Under the direction of qualified coaches, participants will have the opportunity to
develop sports skills to prepare themselves for participation in other community sports programs.
-Competition experiences- Athletes benefit from physical and mental challenges participating in a variety of
competitions organized by Special Olympics or by community sports organizations.
-Meaningful Inclusion- Unified Sports® rules and guidelines on age and ability group help ensure that all
teammates play important, meaningful and valued roles on the team.
-Community-based participation- Unified Sports® programs have found valuable partners in schools, Parks and
Recreation departments, and many more community sports organizations. These partnerships help further
include athletes in their community.
-Friendship and Socialization- This program provides a forum for positive social interaction between teammates
and often leads to long-lasting friendships.
-Transition & Choice- Unified Sports® programs help schools meet the transition mandates of I.D.E.A. and
provide a choice for athletes in and out of Special Olympics.
Long Term Goals of Project UNIFY and Unified Sports®
-Change the school environment in every school in Colorado to be truly inclusive.
-Unified Sports® will be offered in at least one sport at every high school in Colorado.
-Gain CHSAA’s approval of Unified Sports® as a statewide recognized sanctioned sport, giving Unified Sports® all
the athletic benefits of typical school athletic teams.
Three Unified Sports Options of models exist under the umbrella of Unified Sports (All PU Schools must
agree to partake in one of these options throughout the school year):
Unified Sports®
6-9
8
1. Unified Sports
Unified Sports is a competitive model that combines Special Olympics athletes and partners (individuals without
intellectual disabilities) as teammates on sport teams for training and competition. All athletes and partners on a
Unified Sports team must have attained the necessary sport specific skills and tactics to compete without
modification of the current Special Olympics Official Sports Rules. A Unified Sports team is an inclusive sports
program with an approximately equal numbers of athletes and partners. Unified Sports teams should never be
comprised solely of people with disabilities. Athletes and partners should be of similar age and ability. Age and
ability-level matching of athletes and partners are defined on a sport-by-sport basis as set forth in Article 1 of the
Official Special Olympics Sports Rules.
The following two models, Unified Sports Player Development and Unified Sports Recreation, allow for
modifications to the Special Olympics Official Sports Rules. These models will not be conducted as official events
at international Regional and World Games. Additional guidelines for these models will be provided in the Unified
Sports Handbook.
2. Unified Sports Player Development
The Unified Sports Player Development model combines approximately equal numbers of Special Olympics
athletes and partners (individuals without intellectual disabilities) as teammates on sports teams for training and
competition. In Unified Sports Player Development, teammates are not required to be of similar abilities. Players
of higher abilities will assist teammates of lower abilities in developing sport-specific skills and tactics in
successfully participating in a team environment. Age matching of athletes and partners is defined on a sport-by-
sport basis as set forth in Article 1 of the Official Special Olympics Sports Rules. Therefore, Unified Sports Player
Development teams must follow Unified Sports rules with the exception of those rules referring to teammates
being of similar ability. Rules and modifications should ensure the meaningful involvement of all teammates.
Utilized when teammates of higher ability are involved in assisting those of lower ability to improve their
sport-specific skills and tactics. Rules are modified to prevent the dominance of higher ability players as
well as to help define their role as mentors
Has higher ability players mentoring lower ability players
Has modified training and competition rules to prevent player dominance and ensure health and safety, to
define the roles of all players and to foster meaningful involvement.
3. Unified Sports Recreation
Unified Sports Recreation consists of inclusive recreational sports opportunities for Special Olympics athletes and
partners without intellectual disabilities. This model promotes social inclusion and increases sport-specific skills
and knowledge. However, the composition of Unified Sports Recreation teams is less structured thank Unified
Sports and Unified Sports Player Development teams. Unified Sports Recreation teams do not meet the minimum
training, competition and/or team composition requirements as set forth in Article 1 of the Official Special
Olympics Sports Rules. These opportunities may take place in schools. Clubs. Community and or private or public
organizations.
Currently not an official competition opportunity but is an approved exhibition or demonstration
at Special Olympics. In schools, it fulfills the Project UNIFY criteria of inclusive sports
Includes training (like physical education class) or competition (like intramural sports) in which
athletes and partners take part together over the course of a season or a semester
Includes sports and other physical activities ranging from basketball to yoga. Activities that qualify
for Unified Sports Recreation must be physical, not cerebral or artistic (such as chess or painting).
Does not require teams to be composed of athletes and partners of similar age and ability.
6-10
9
Examples:
Physical Education Class: A high school physical education class includes students with and without
intellectual disabilities who play basketball every day for a semester
Partners Club: A group of soccer club members with and without intellectual disabilities decide as
a regular part of their club activity to go bowling on Saturday afternoons
Intramural Team: A group of university students invite local Special Olympics athletes to play
volleyball on Sunday evenings
Exhibition/Demonstrations: a one-day recreational competition is held with a school, mainstream
sports club, or community sports program that features individuals with and without intellectual
disabilities.
6-11
10
Make contact with Special Olympics Colorado
-Set up a meeting
-Determine specific team needs and support roles for team
-Communicate with SOCO in regards to possible funding assistance
Choose the Sport
-SOCO designates these sports as a part of Project UNIFY® within our schools:
-Flag Football, Basketball, Soccer
-Outside of Project UNIFY SOCO offers these Unified Sports®:
-Bowling -Tennis -Bocce -Cycling -Track & Field
-Cross Country Skiing -Volleyball -Softball -Golf -Snowshoeing
-Figure Skating -Speed Skating
Find a Coach
-Be sure coaches complete the Coaches Training offered on the Special Olympics Colorado website
within 1 year of becoming a coach
-Hold interest meeting at school to promote team
-Look for those who are passionate about the cause
Recruit Special Olympics Athletes
-Athletes are anyone who has an intellectual disability, of any ability level.
-Athletes also include people who have closely related intellectual disabilities, such as those who
have functional limitations, both in general learning and in adaptive skills such as recreation, work,
independent living, self-direction or self-care. Many eligible SO athletes may not be in ILC or
Special Education Classrooms.
-Ask for permission to send a school-wide email with details about the program and contact
information.
-Meet the Special Education staff in your school to help identify and recruit athletes.
-We strongly advise you to start small. It is much better to start out with just a few athletes with
disabilities and then grow the program after success is evident.
Recruit Unified Partners
-Individuals without disabilities, interested in participating in the sport of your choice.
-Be sure to find an equal number of Partners and Athletes.
-Ideal Unified Partners might include members of Student Leadership or Student Government.
-It is also a good idea to look towards the students who were cut from JV or Varsity Athletic teams
to be Unified Partners for the same sport.
Turn in your teams medical/consent forms (All master copies can be found at the end of this workbook,
copy & distribute as needed- PLEASE RETURN ALL FORMS TOGETHER IN ONE PACKET TO Allo Perry AT
SOCO OFFICE)
a. Special Olympics Athletes must fill out Application for Participation (SOCO medical is valid for 3
years)- Must be signed by Medical professional before first practice
2
.
3
.
5
4
.
6
.
How to Start a Unified Sports® Team Checklist
1
.
6-12
11
b. Unified Partners must fill out Special Olympics Colorado Class “A” Volunteer
Application & return to SOCO office; All parts including copies of photo ID’s, Protective Behavior
Quizzes & Reference Forms must be included
c. Unified Coach must fill out first two pages of the Special Olympics Colorado Class “A” Volunteer
Application & return to SOCO office
d. Ensure school Principal has signed Special Olympics Colorado Endorsement Letter, this should
already be completed if your school is actively involved with Project UNIFY.
Secure a facility and set team schedule
-Inform school Athletic Director of practice schedule and facility needs
-Develop a competition schedule with other League Coaches
-Provide SOCO with competition schedule
-Reserve buses if needed
Recruit Additional Volunteers
-Ask parents of athletes and partners if they would be willing to help out with practice etc.
-Look for team fundraising opportunities. Money can be used for uniforms, equipment, travel or
team parties
-Add parents to your Booster Club
Hold regular practices and competitions
-Unified Sports® Teams should practice and compete similarly to any other high school team
-Be sure partners & athletes are recognized at your school’s Athletic Awards Banquet or any sports
assembly
Participation in one SOCO event
-All schools are encouraged to attend a minimum of one Special Olympics Colorado Regional or
State Event/Competition
-Your Special Olympics Colorado Regional Manager can provide you with details for these events
Ongoing communication with school personnel & SOCO
-Set up meeting with coaches and SOCO staff if needed
-Ensure ongoing communication with Special Olympics Colorado
Who can be a Unified Partner?
The desired objectives of a Unified Sports® experiences are best fulfilled when partners on a team are individuals
without disabilities. Special Olympics Unified Sports® teams should never be composed solely of people with
disabilities. Special Olympics Unified Sports® is a program that combines approximately an equal number of
Special Olympics athletes and athletes without disabilities.
Special Olympics Colorado Coaches Training- REQUIRED
-Purpose- To ensure that each coach has the knowledge and tools to train athletes according to sport, safety and
Special Olympics guidelines.
-Timeline- Initial training must be completed within the first year of coaching. Certifications will be good for 3
years. All testing requirements and applications must be completed and submitted to SOCO before certification
completion can take place.
Complete Level I Certification Online Here: http://www.specialolympicsco.org/get/become_a_coach.html Unified Sports® Coaches Guides (Rules and Regulations for each individual sport can be found here): http://www.specialolympics.org/sports.aspx
9
.
8
.
7
.
11
10
6-13
12
Suggested Lettering Requirements For Colorado High Schools
Point System
Required to letter – 100 points Practice – 1 point per session Regional Meet – 15 points for participation State Meet – 25 points for participation Points will be subtracted for behavior problems Must maintain passing grades Must have recommendation of the coach
Participation System (for current 4 season offering) Participate at Regional level in 4 seasons during 1 year Participate at Regional level in 3 seasons for 2 years Participate at Regional level in 2 seasons for 3 years Participate at Regional level in 1 season for 4 years Must have recommendation of the coach.
Suggested Lettering Guidelines for Unified Teams
6-14
13
School based Unified Sports Teams are invited to play at our Special Olympics Colorado regional and state competitions. A roster with a certified coach will need to be submitted to your SOCO regional manager by a seasonal deadline.
Below you can determine which region your school team is located in and you will find contact information for your regional manager. Your regional manager will be able to provide you details about dates of competitions and how to register your team for SOCO’s regional and state competitions. Participating in these competitions is a great opportunity for your team to play new teams/schools and compete at a higher level.
Denver Metro Region The Denver Metro Region serves Denver and Adams Counties. For further information please contact: Freda Davenport Phone: 720-359-3114 [email protected]
Mile High Region
The Mile High Region serves Arapahoe, Elbert, Douglas, Clear Creek, Gilpin and Jefferson Counties. Please contact: Sam Miller Phone: 720-359-3104 [email protected]
Northeast Region
The Northeast Region serves Boulder, Cheyenne, Kit Carson, Larimer, Lincoln, Logan, Morgan, Phillips, Sedgwick, Washington, Weld and Yuma Counties. Please contact: Jan Radnoti Phone: 970-301-4623 [email protected]
Southeast Region
The Southeast Region serves Alamosa, Baca, Bent, Chaffee, Conejos, Costella, Crowley, Custer, El Paso, Fremont, Huerfano, Kiowa, Lake, Las Animas, Otero, Park, Prowers, Pueblo, Rio Grande, Saquache and Teller Counties. Please contact: Jolie Nesmith Phone: 719-574-8480 [email protected]
Western Region
The Western Region serves Delta, Eagle, Garfield, Grand, Gunnison, Jackson, Mesa, Moffat, Montrose, Ouray, Pitkin, Rio Blanco, Routt and Summit Counties, Archuletta, Dolores, Hinsdale, La Plata, Mineral, Montezuma, San Juan and San Miguel Counties. Please contact: Julie Fite Phone: 970-945-0395 [email protected]
SOCO Regional Competitions
6-15
14
All Special Olympics coaches agree to observe the following code: Respect for Others I will respect the rights, dignity and worth of athletes, coaches, other volunteers, friends and spectators in Special Olympics. I will treat everyone equally regardless of sex, ethnic origin, religion or ability. I will be a positive role model for the athletes I coach. Ensure a Positive Experience I will ensure that for each athlete I coach, the time spent with Special Olympics is a positive experience. I will respect the talent, developmental stage and goals of each athlete. I will ensure each athlete competes in events that challenge that athlete’s potential and are appropriate to that athlete’s ability. I will be fair, considerate and honest with athletes and communicate with athletes using simple, clear language. I will ensure that accurate scores are provided for entry of an athlete into any event. I will instruct each athlete to perform to the best of the athlete’s ability at all preliminaries and final heats in accordance with the Official Special Olympics Sports Rules. Act Professionally and Take Responsibility for My Actions My language, manner, punctuality, preparation and presentation will demonstrate high standards. I will display control, respect, dignity and professionalism to all involved in the sport (athletes, coaches, opponents, officials, administrators, parents, spectators, media, etc.). I will encourage athletes to demonstrate the same qualities. I will not drink alcohol, smoke or take illegal drugs while representing Special Olympics at training sessions, competition or during games. I will refrain from any form of personal abuse towards athletes and others, including inappropriate or unwanted sexual advances on others, verbal, physical and emotional abuse. I will be alert to any form of abuse from other sources directed toward athletes in my care. I will abide by the Special Olympics policy on the prohibition of coaches dating athletes. Quality Service to the Athletes I will seek continual improvement through performance evaluation and ongoing coach education. I will be knowledgeable about the Sports Rules and skills of the sport(s) I coach. I will provide a plan for a regular training program. I will keep copies of the medical, training and competition records for each athlete I coach. I will follow the Special Olympics Sports Rules for my sport(s). Health and Safety of Athletes I will ensure that the equipment and facilities are safe to use. I will ensure that the equipment, rules, training and environment are appropriate for the age and ability of the athletes. I will review each athlete’s medical form and be aware of any limitations on that athlete’s participation noted on that form. I will encourage athletes to seek medical advice when required. I will maintain the same interest and support toward sick and injured athletes. I will allow further participation in training and competition only when appropriate. I understand that if I violate this Code of Conduct I will be subject to a range of consequences, up to and including being prohibited from coaching in Special Olympics.
Special Olympics Colorado Coaches Code of Conduct
6-16
15
Special Olympics is committed to the highest ideals of sport and expects all athletes to honor sports and Special Olympics. All Special Olympics athletes and Unified Sports® partners agree to the following code: Sportsmanship I will practice good sportsmanship. I will act in ways that bring respect to me, my coaches, my team and Special Olympics. I will not use bad language. I will not swear or insult other persons. I will not fight with other athletes, coaches, volunteers or staff. Training and Competition I will train regularly. I will learn and follow the rules of my sport. I will listen to my coaches and the officials and ask questions when I do not understand. I will always try my best during training, divisioning and competitions. I will not "hold back" in preliminaries just to get into an easier final heat. Responsibility for My Actions I will not make inappropriate or unwanted physical, verbal or sexual advances on others. I will not drink alcohol, smoke or take illegal drugs while representing Special Olympics at training sessions, competition or during games. I will not take drugs for the purpose of improving my performance. I will obey all laws and Special Olympics rules. I understand that if I do not obey this Code of Conduct my Program or a Games Organizing Committee may not allow me to participate.
Special Olympics Colorado Athlete Code of Conduct
6-17
16
Spread the Word to End the Word is an on-going effort to raise the consciousness of society about the
dehumanizing and hurtful effects of the word "retard(ed)" and encourage people to pledge to stop using the R-
word. The use of the word R-word hurts individuals with intellectual disabilities, their family members, and their
friends. The campaign, which peaks in March every year (but is ongoing throughout the year), is intended to get
schools, communities and organizations to rally and pledge their support. Spread the Word to End the Word™ is a
youth driven campaign and every day there are young people, as well as family members and advocates, who are
creating positive change within schools and communities to foster dignity, respect, acceptance, and tolerance for
all individuals with intellectual disabilities.
What are some ideas for other rallies?
Many students around the country have hosted rallies in the past. Each one is a little different, so you should put
together a youth leadership team to start planning the details. You’ll need to figure out how many people will
attend, who will be your speakers, which Special Olympics athletes will be there, and how you can make the event
exciting for everyone who is there. Students will need to decide what type of rally would best fit their school.
Who do I talk to, to hold an event at my school?
This often depends on your school. You should definitely work with a teacher to help you and your youth team as
you plan for the event. You might also need to get permission from your principal, and you’ll want to talk to your
school office about setting up a time and place. Make sure you do this early so you can set up a timeline!
Where do I get the R-Word Supplies?
Every year in March, for the annual Spread the Word to End the Word Day, Special Olympics designs t-shirts,
posters, stickers and other materials for schools to hand out at their campaign. All Project UNIFY Schools will
receive these materials free of charge upon request through Special Olympics Colorado. If you are not a Project
UNIFY School and wish to hold a campaign you may order your own materials online at www.r-word.org.
What different clubs can I use to help me out?
National Honor Society, Student Council or other Student Leadership groups would be a great place to recruit
people to help you put on your campaigns. You should also consider partnering up with some students in the
Special Education department to help you put on your campaign.
R-Word
6-18
17
Step-by-Step This campaign is designed to be organized and led by students for the students. Have
fun!
One Week Before –
Hang up posters
Recruit at least 6 student volunteers for each lunch period
Start school announcements introducing the R-word campaign
Day of Campaign –
Set up a table in the lunch room or hall near cafeteria
Have volunteers set up 20 minutes before lunch
Give volunteers a t-shirt for helping
Place pledge banner on one table with markers for students to
sign
After the Campaign –
Clean up and put tables away
Hang up pledge banner in an area for everyone to see
Give Away Prizes –
Each school can determine how they want to give out extra t-shirts, wristbands and shoe laces.
Other Ideas–
Do a drawing after the campaign for prizes
Toss the t-shirts, wristbands, shoe laces in the stands at assembly or during lunch
Get raffle tickets and write down shirt, wristband, shoe lace or candy and have each person draw for prize. Take the ticket to the prize table to claim the prize. Guessing game how much candy is in the jar – 10 closest receive a shirt, next closest a wristband and so on Fact Trivia after an R-word presentation on facts about Special Olympics
Thanks for ‘Poppin In’- Print labels and put on bags of popcorn to hand out during the campaign!
We are ‘Nuts’ about this Campaign- Print labels and put on bags of nuts to hand out during the campaign!
R-Word Continued
6-19
18
No one likes playing or competing in front of empty bleachers! It’s easy to get Fans in the Stand started at your
school – bring a group of friends, design big posters, gather at a local Special Olympics or Unified Sports® game
or tournament, and cheer like crazy! Whether athletes are on the court, field, or in the stadium, having cheering
fans in the stands can be crucial to the motivation (and outcome) of the team! Encourage members of your
school to organize groups to be at every game or tournament to support Special Olympics athletes year-
round. Start Fans in the Stands at your school to ensure that every athlete and team has supporting fans who
cheer every game, rain or shine, win or lose.
Where should I have an event?
You can contact your local Special Olympics program to find out what sports they offer, and what times they
practice and compete so you can choose a time good for you and your friends!
How do I advertise the event?
Contact Special Olympics Colorado, as they can post it on their website and tell the teams that you are coming.
You can put out flyers at your school and have it included in the school announcements. You could even contact
your local newspaper!
What are cool things to bring?
You can get big poster board, markers, and fun crafty items to make signs and posters! You might even be able to
contact the coach to get the athlete’s names. You can also buy face paint, streamers, and clappers! T-shirts are
also a great way to make your group of fans stand out! SOCO might have some left over Pom Poms or
Megaphones you could use, be sure to ask!
What type of events can I have before the game?
There are lots of fun ways to get ready for the game. You can have the poster-making and face-painting be an
event all on its own before the game. You could also have a BBQ or order pizza so all of the fans have tons of
energy before the game starts. You can bring music to get everyone pumped!
Who can I reach out to for ideas and see what they have done?
Special Olympics Colorado should be able to help you get started. You can also go on the Special Olympics Fan
Community site, and also check out other Fan Pages on Facebook! http://specialolympicsco.org/
Fans in the Stands
6-20
19
-Make Signs -Use Megaphones
-Bring your friends -Bring Clappers/Noise Makers
-Use Pom Poms -Paint your Face
-Cheer Loud -Do the Wave
Fans in the Stands Continued
6-21
20
The Partners Club® is a unique Special Olympics school based program that brings together students
with and without intellectual disabilities, through sports skills training and competition (Unified
Sports®) on a regular basis. This club offers other social and recreational opportunities as well for
members to spend additional time together. Student members need not be varsity or junior varsity
athletes, but may have a particular career or sport interest. A Partners Club® should be a sanctioned
school club; the meeting schedule and format follows school club policies and procedures. Clubs have a
faculty advisor and officers who network with administration, as well as build a partnership with the
physical education and special education departments.
Why start a partners club?
Partners Club help provide a place where students of all abilities can come together and interact and
have fun together. Partners Club really helps to unite a school and highlight the abilities of everyone!
Partners Clubs can help plan and organize R-Word Events, Fans in the stands and school rallies.
How do I get people to join?
Well, sports are normally a good way to get students involved, so reach out to sports teams and see if
any of their members would like to join. Pizza or other foods are also a nice way to get people to come
to a meeting. Recruit athletes from the Special Education department at your school.
How would we pay for our events?
Talk to your school and Special Olympics Colorado to see if they have money that they could use to help
you start your club. You could also make one of your activities a fundraiser. For bigger events, there are
youth grants that Special Olympics Project UNIFY offers, you can download the application online.
How do we organize Sports events?
Your Partners Club might want to organize into a Unified Sports® team. Unified Sports® teams bring
together youth with and without intellectual disabilities to play together. Contact Special Olympics
Colorado office to see if there are other Unified Sports® teams in your region that you can compete
against. There might even be a league schedule you could get your team involved in.
Partners Clubs®
6-22
21
Here are some fun ideas your Partners Club can do together:
Be Fans in the Stands
Partners Clubs Continued ®
Participate in the Polar Plunge
Have a Holiday Party/ Game Day
Make Signs for an Upcoming Game
6-23
22
The Get Into It, is a curriculum resource kit for students with and without intellectual disabilities. This service-
learning guide is age-appropriate and is designed to advance students civic knowledge and skill development,
promote acceptance and understanding of peoples differences and to motivate them to become advocates for
people with intellectual disabilities. This is a curriculum that celebrate giftedness- the giftedness of every student
whatever his or her ability. Through the world of Special Olympics we hope each student will come to recognize
that he or she has the power to make a difference.
Through Get Into It, students will engage in fun, interactive and creative activities that promote respect and
acceptance and teach about this important social movement. Most important they will be invited to make a
difference themselves. Get Into It is a portal through which young people can discover the pathway to building a
more inclusive society for all. www.specialolympics.org/getintoit
Each Project UNIFY School will receive a hard copy of the Get Into It Service Learning Guide. More guides will be
provided to the schools upon request.
Some of the resources in the Get Into Curriculum include:
-Inspiring athlete stories that demonstrate true triumph and teamwork
-Use of Get Into It as a tool for anti-bullying and teasing campaigns in and out of the classroom
-Lessons compatible with character education along with inclusive classroom modifications and general
extensions
-Emphasis of lessons on academic domains such as language arts, social studies, health, civics,
government, technology, history and cross-curricular extensions
Get Into It Active:
The Get Into It Active is a set of free, K-12 service learning lessons and resources designed to advance students
civic knowledge and skill development while promoting acceptance and understanding to motivate youth to
become advocates for and together with all people. The content of these lessons are based on the ability,
dedication and inspiration found in the millions of Special Olympics athletes around the world.
Get Into It Active is a condensed version of the Get Into It Lessons with a focus on physical activities and
discussions while Get Into It lessons and resources are used in classrooms around the country, Get Into It Active is
designed for homeroom, after school programs, recess, or other less structured environments. Get Into It Active is
also designed to enhance sporting activities, taking place in a physical education class, or on a Special Olympics
Unified Sports® Team.
Each Project UNIFY School will receive a hard copy of the Get Into It Active. More guides will be provided upon the
schools request.
Movies that Move DVD:
Movies that Move provides an opportunity for all students, regardless of ability or background, to discuss
inclusion, acceptance, the power of words and youth leadership while building new relationships with each other
and working together to transform their school climate from the inside out. The Movies that Move DVD are TV
Show and film clips that promote inclusion & critical thinking. These are popular films and TV Shows designed to
spark meaningful discussion in the classroom.
Get Into It Service Learning Guide
6-24
23
Project UNIFY Youth Leadership Summit
In November of 2011, Special Olympics Colorado hosted their first annual Project UNIFY Youth Leadership
Summit. This summit was a daylong event that took place at Cherokee Trail High School. There were around 150
youth and educators that attended the summit from 48 different schools. This Youth Leadership Summit is totally
free and open to Special Olympics Athletes and Partners in the middle and high school age level. Educators are
also encouraged to attend.
The Summit is designed to inform students about Project UNIFY and all the different initiatives it offers. There are
breakout sessions at the Summit in areas including the Polar Plunge, R-Word Campaigns, Unified Sports®, Global
Messenger Training and more.
In 2014, Special Olympics Colorado offered their 4th Annual Project UNIFY Youth Leadership Summit at a local
Denver Public School. Lunch, snacks, t-shirts and more goodies are provided to all the Youth that attend the
Summit. The Project UNIFY Youth Leadership Summit will be held annual usually sometime in the fall, location is
subject to change.
Global Messenger Training
The Global Messenger Training is a weekend long training designed to enhance Special Olympics Athletes and
Peer Partners skills on how to speak on behalf of Special Olympics Colorado.
Once the training is complete and the athlete/partner is a Global Messenger they are encouraged to make
speeches emphasizing the importance of Special Olympics. Many Global Messengers will be asked by SOCO Staff,
Schools, and Sponsors to make speeches at events.
Group Picture from the 2012 Global Messenger Training at Snow Mountain Ranch in Grandby, CO
Project UNIFY Youth Leadership Summit ®
6-25
24
Sent
Video- What is Project UNIFY : ®
http://www.youtube.com/watch?v=xk0_5qAJ5QMchool
Project UNIFY Informational Flyer: ®
http://media.specialolympics.org/soi/files/resources/Project_Unify/ProjectUNIFYInformationalFlyer.pdf
Project UNIFY “It’s Our School Too” Play Script: ®
http://media.specialolympics.org/soi/files/resources/Project_Unify/Its_Our_School_Too%20Script.pdfee
ment
Project UNIFY School Banner: ®
http://media.specialolympics.org/soi/files/resources/Project_Unify/4by8GenericPUBannerFinal.pdf
Get Into It Brochure:
http://media.specialolympics.org/soi/files/resources/Schools_Youth/Jenni_Getinotit_WEB.pdf
Unified Sports® Handbook:
http://media.specialolympics.org/soi/files/sports/UnifiedSports.pdf
Special Olympics Colorado Project UNIFY Facebook Page: ®
http://www.facebook.com/#!/pages/Special-Olympics-Colorado-Project-UNIFY/161963520566903
Special Olympics Colorado Twitter Page:
https://twitter.com/SpecOlympicsCO
Additional Project UNIFY Resources ®
6-26
25
Schools who wish to participate in Project UNIFY are agreeing to partake in three main initiatives of Project ®
UNIFY:
-School Wide Collaboration (e.g. R-Word campaign, Youth Rallies, Assemblies)
-Unified Sports® (e.g. Unified Sports® Team, Unified Gym Class, Unified Field Day, Unified Clinic)
-Youth Leadership (Attendance at PU Youth Summit, Youth led activities)
Throughout the duration of the school year each Project UNIFY School must participate in all of these initiatives.
Below is an example of the School Agreement form that will need to be signed by your School Principal and
School Liaison. If interested in becoming a PU School an agreement letter will be created for your school
specifically.
School Name
Street Address
City, State, Zip
Dear (Principal Name);
I am pleased to ask for the endorsement of (School Name) as a Project UNIFY School. It is recognized that Project UNIFY and its many initiatives such as
Unified Sports, Partner Clubs, the Get Into It Service-Learning Guide and R-word/Spread the Word to End the Word campaigns positively impact the school
community as a whole. This approach compliments the objectives of our educators and youth to create a school climate fostering respect and tolerance for
all students and specifically those with intellectual disabilities.
As a Project UNIFY school, (School Name) agrees to:
1. Develop and implement a minimum of one Unified Sports Program/Young Athletes Program involving students with and without intellectual disabilities playing together. Examples:
a. Unified Sports Team b. Unified Field Day c. Unified Gym Class d. Unified Sports Clinic
2. Implement at least two or more of the following youth leadership/youth activation opportunities: a. Youth rally/youth forum b. Youth Leadership Training- Youth Attending SOCO Youth Summit/ Global Messenger Training c. Youth as volunteers d. Identify 3-5 Youth with leadership potential to serve as Young Athlete Program Mentors or PU Role Models e. Partner Clubs- brings together students with and without intellectual disabilities f. Participation in Spread the Word to End the Word activities
3. Utilize the Get Into It Service Learning Guide, Get Into It Active or Movies that Move DVD as part of the school’s leadership, service learning and/or
social justice modules at participating schools.
4. Provide a school based liaison to work with Special Olympics Colorado. This person will act as the main point of contact for the school concerning
all Project UNIFY activities. It is understood that the liaison will be asked to provide a regular status updates on inclusive activities taking place at
(School Name). A liaisons responsibilities will include:
a. Fill out monthly Report surveys on behalf of Project UNIFY Initiatives taking place at their school.
b. Help promote and recruit students to attend the Special Olympics Colorado Youth Leadership Summit.
c. Ensure all aspects of Project UNIFY are being conducted at their school.
d. Encourage and provide support to Project UNIFY initiatives taking place throughout their school.
Over
5. Participate in pre and post evaluations as outlined by Project UNIFY.
In turn, it is understood that Special Olympics Colorado will:
1. Provide consultation, education, support and assistance for all Unified sports programs and activities that promote inclusion, acceptance, respect and dignity for all students.
2. Provide resources to support school based Project UNIFY activities (as agreed). 3. Provide training for Unified coaches upon request. 4. Provide Project UNIFY policies and procedures, training manuals, schedules, Athlete and Unified Sports Partner paperwork, General Rules etc. 5. Provide instruction and assistance to school administration. 6. Provide access to Special Olympics Colorado volunteers when requested. 7. Provide Special Olympics Colorado Project UNIFY logo for schools to use in accordance with PU Initiatives. 8. Provide materials and support for R-Word campaigns, fundraising and youth leadership activities.
School Agreement
6-27
384 Inverness Parkway, Suite 100, Englewood, CO 80112 Tel 720-359-3100 www.specialolympicsco.org Revised December 20, 2014
26
APPLICATION FOR PARTICIPATION
Colorado
ATHLETE INFORMATION
Last Name______________________________________ First Name_____________________________ MI_______________
Street Address__________________________________ City___________________________________ Zip_______________
Home Phone____________________________________ Cell Phone_____________________________ DOB____/____/___
E-Mail Address___________________________________ Gender Male Female
Ethnicity White Black/African American Asian Hispanic/Latino Other
Employer_______________________________________ Position_______________________________
Dates of Employment_____________ to ____________ Work Phone___________________________
Local Program/Team/School:________________________________________________________________
DOES THE ATHLETE HAVE (CIRCLE ANY THAT APPLY):
Autism Cerebral Palsy Down Syndrome Fetal Alcohol Syndrome Fragile X Syndrome Other________________
PARENT/CAREGIVER #1 INFORMATION
Last Name______________________________________ First Name____________________________
Street Address__________________________________ City___________________________________ Zip_______________
Home Phone____________________________________ Cell Phone_____________________________
E-Mail Address___________________________________
Employer________________________________________ Position_______________________________
Does your employer have a Giving/Corporate Matching Program? Yes No
**This information is strictly confidential and is collected for grant reporting purposes only. Your personal data will not be shared or used to identify you.
PARENT/CAREGIVER #2 INFORMATION
Last Name______________________________________ First Name____________________________
Street Address__________________________________ City___________________________________ Zip_______________
Home Phone____________________________________ Cell Phone_____________________________
E-Mail Address___________________________________
Employer________________________________________ Position_______________________________
Does your employer have a Giving/Corporate Matching Program? Yes No
HEALTH INSURANCE/EMERGENCY CONTACT INFORMATION
Emergency Contact__________________________________ Phone Number________________________
Do you have health insurance? Yes No
Medical Insurance Company___________________________ Policy Number________________________
6-28
384 Inverness Parkway, Suite 100, Englewood, CO 80112 Tel 720-359-3100 www.specialolympicsco.org Revised December 20, 2014
27
LAST NAME________________________________ FIRST NAME_______________________________
MEDICATIONS (PLEASE ATTACH AN ADDITIONAL SHEET IF NECESSARY)
Medication Name Dosage Date Prescribed Times Per Day ______________________________ _________________ _________________________ ___ ________________
______________________________ _________________ _________________________ ___ ________________
______________________________ _________________ _________________________ ___ ________________
______________________________ _________________ _________________________ ___ ________________
______________________________ _________________ ____________________________ ________________
______________________________ _________________ _________________________ ___ ________________
______________________________ _________________ _________________________ ___ ________________
______________________________ _________________ _________________________ ___ ________________
______________________________ _________________ _________________________ ___ ________________
______________________________ _________________ ____________________________ ________________
HEALTH HISTORY
Heart Disease/Heart Defect/High Blood Pressure Yes No Allergies Yes No
Chest Pain Yes No Medicines Yes No
Seizures/Epilepsy/Fainting Spells Yes No Food Allergies Yes No
Diabetes Yes No Insect Stings/Bites Yes No
Concussion/Serious Head Injury Yes No Assistive Devices Yes No
Concussion Symptoms Yes No Easy Bleeding Yes No
Major Surgery/Serious Illness Yes No Visually Impaired Yes No
Emotional/Psychiatric/Behavioral Yes No Sickle Cell Trait Disease Yes No
Blindness/Visual Problem Yes No Contact Lenses/Glasses Yes No
Heat Stroke/Exhaustion Yes No Bone/Joint Problem Yes No
Hearing Loss/Hearing Aid Yes No Non-Verbal Yes No
Immunizations Up to Date Yes No Other__________________ Yes No
Date of Most Recent Tetanus Immunization _____/_____/_____ ______________________________________
6-29
384 Inverness Parkway, Suite 100, Englewood, CO 80112 Tel 720-359-3100 www.specialolympicsco.org Revised December 20, 2014
28
LAST NAME________________________________ FIRST NAME_______________________________
RELEASE FORM
I, the undersigned, represent and warrant that, to the best of my knowledge and belief, I am/my child is/my ward is physically and mentally able to participate in Special Olympics
Colorado. With my approval, licensed physicians is authorized to review the health information set forth in this application and administer a medical examination so as to certify
that there is no medical evidence which would preclude me/my child/my ward from participation. I understand that if I/my child/my ward has Down Syndrome, I/he/she cannot
participate in sports or events which by their nature result in hyper-extension, radical flexion or direct pressure on the neck or upper spine, unless a full radiological examination
establishes the absence of Atlanto-axial instability. I am aware that the sports and events for which this radiological examination is required are judo, equestrian sports, gymnastics,
diving, pentathlon, butterfly stroke, diving starts in swimming, high jump, alpine skiing, squat lift, snowboarding and soccer team competition. Initial____________
Special Olympics Colorado has my permission to use my/my child’s/my ward’s likeness, name, voice and words in television, radio, film, newspaper, magazines and any other media,
and in any form, for the purpose of advertising or communicating the purpose and activities of Special Olympics Colorado and/or applying funds to support those purposes and
activities. Initial____________
If a medical emergency should arise during my/my child’s/my ward’s participation in any Special Olympics Colorado activities and I am not able to give my consent, for whatever
reason, I authorize Special Olympics Colorado to take whatever measures are necessary and which it deems advisable, to protect my/my child’s/ my ward’s health and well-being,
including hospitalization. Initial____________
I acknowledge that Special Olympics events may involve overnight activities and that the housing arrangements for each event may differ. I understand that I should contact my
local Area Manager if I have any questions about housing arrangements for a specific event or the housing policy in general. Initial____________
I acknowledge that Special Olympics requires each coach to pass an approved concussion awareness and safety recognition program and I have read the policy as posted on.
www.specialolympicsco.org. Initial____________
I have read and fully understand the provisions of the above release and have explained the provisions to my child/ward. I understand that through my signature on this release
form, I am agreeing to the above provisions on my own behalf or on the behalf of my child/ward, and hereby give my permission for my child/ward to participate in Special
Olympics Colorado games, recreation programs and physical activities. Initial____________
Clearly Print Athlete Name____________________________________________________________
Signature of Adult Athlete/Parent/Caregiver____________________________________________ Date______/______/______
6-30
384 Inverness Parkway, Suite 100, Englewood, CO 80112 Tel 720-359-3100 www.specialolympicsco.org Revised December 20, 2014
29
LAST NAME________________________________ FIRST NAME_______________________________
PHYSICAL EXAMINATION – TO BE COMPLETED BY LICENSED PHYSICIAN
Licensed Medical Examiners: It is recommended that the examiner review items on the medical history with the athlete or their guardian,
prior to performing the physical exam.
Blood Pressure______/______ Weight__________ Height__________ BMI__________
Normal Abnormal Normal Abnormal Normal Abnormal
______ ______ Vision ______ ______ Cardiovascular System ______ ______ Cranial Nerves
______ ______ Hearing ______ ______ Respiratory System ______ ______ Coordination
______ ______ Oral Cavity ______ ______ Gastrointestinal System ______ ______ Reflexes
______ ______ Neck ______ ______ Genitourinary System ______ ______ Skin
______ ______ Extremities
______ Athlete does not have any neurological symptoms or physical findings that could be associated with spinal cord
compression or atlantoaxial instability.
______ Athlete has neurological symptoms or physical findings that could be associated with spinal cord compression or
atlantoaxial instability and therefore must receive an additional neurological evaluation to rule out additional risk of
spinal cord injury prior to clearance for sports participation.
Licensed Medical Examiners: It is recommended that the examiner review items on the medical history with the athlete or their guardian,
prior to performing the physical exam. If an athlete is deemed to need further medical evaluation, please provide them with the
necessary referrals.
______ This athlete IS ABLE to participate in Special Olympics sports. (Please note any limitations or restrictions.)
______ This athlete MAY NOT participate in Special Olympics sports at this time and must be evaluated by a physician for the
following concerns:
______Concerning Cardiac Exam ______Acute Infection ______Oxygen Saturation Less Than 90%
on Room Air
______Concerning Neurological Exam ______Stage II Hypertension ______Hepatomegaly or Splenomegaly
or greater
______Other, please describe______________________________________________________________________________________________
ADDITIONAL LICENSED EXAMINER’S NOTES – FOLLOW UP WITH A:
______Cardiologist ______Neurologist ______Primary Care Physician ______Vision Specialist
______Hearing Specialist ______Dentist/Hygienist ______Podiatrist ______Physical Therapist
______Nutritionist ______Other_________________________________________________________________________________
Licensed Medical Examiner’s Signature NAME____________________________________________________
__________________________________________________________ E-MAIL___________________________________________________
LICENSE #________________________________________________ PHONE______________________ DATE____________________
6-31
30
NEW RENEWAL MY INFORMATION HAS CHANGED
As a Class “A” volunteer for Special Olympics Colorado, you must complete this application every three years. All Class “A” volunteers must complete the entire form and sign it before your application can be processed.
Please submit the COMPLETED application to SOCO’s Volunteer Manager. Incomplete applications will be returned.
PLEASE INCLUDE:
Complete Application
Photocopy of a Picture ID (must be able to read)
CONTACT INFO
Last Name First Name
Middle Name Nickname
Mailing Address County
City State Zip
Email Cell Phone ( )
Home Phone ( ) Fax ( )
EMPLOYMENT or SCHOOL INFO
Employer Name/School Name
Position/Grade
Address County
City State Zip
Employee Giving or Matching Program Yes No Work Phone
EMERGENCY CONTACT
Name Relationship Phone ( )
POSITION OF INTEREST
Coach Office Support Medical Team Young Athletes Coach
Unified Sports Partner Photography/Video Games Organizing Committee
Global Messenger Mentor
Assistant Coach LETR Local Program Coordinator
Chaperone
PLEASE ANSWER THE FOLLOWING QUESTIONS
1. Do you use illegal drugs? Yes No
2. Have you ever been convicted of a criminal offense? Yes No
3. Have you ever been charged with neglect, abuse or assault? Yes No
4. Has your driver’s license ever been suspended or revoked in any state or other jurisdiction?
Yes No
5. Other than the above, is there any fact or criminal circumstance involving you or your background that would call into question you being entrusted with the supervision, guidance, and care of people with disabilities or handling of large sums of money?
Yes No
6. If you answered YES to any of the above, please explain:
SOCO Class “A” Volunteer Application (3 pgs.)
6-32
31
PERSONAL REFERENCES (Youth applicants please see page 3)
Name Relationship
Phone ( ) Email
Name Relationship
Phone ( ) Email
Special Olympics Colorado Unified Sports® Partner Release and Waiver of Liability
In consideration of participating in The Special Olympics Unified Sports® program, I represent that I understand the nature of the event and that I am qualified, in good health, and in proper physical condition to participate in Unified Sports® events. I fully understand the event involves risks of serious bodily injury which may be caused by my own actions or inactions, by the actions of others participating in the event, or by conditions in which the event takes place. I fully accept and assume all such risks and all responsibility for losses, costs, and/or damages I may incur as a result of my participation. I acknowledge that at any time if I feel that the event conditions are unsafe, I will discontinue participation immediately.
If during my participation in Special Olympics activities I should need emergency medical treatment and I am not able to give my consent for, or make my own arrangements for that treatment because of my injuries, I authorize Special Olympics Colorado to take whatever measures are necessary to protect my health and well-being, including, if necessary, hospitalization.
I release, indemnify, covenant not to sue, and hold harmless Special Olympics Colorado, its administrators, directors, agents, officers, volunteers, employees, other Unified Sports® participants, sponsors, advertisers, and if applicable, any owners and lessors of premises on which the activity takes place from all liability, any losses, claims (other than that of the medical accident benefit), demands, costs, or damages that I may incur as a result of participation in Unified Sports® events and further agree that if, despite this ‘Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement,’ I, or anyone on my behalf, makes a claim against any of the Releases, I will indemnify, save and hold harmless each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage or cost which may incur as a result of such claim. I have read this ‘Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement’ and fully understand it.
Volunteer Code of Ethics
• Fulfill assignment responsibility: Carry out all aspects of your assignment; attend all required meetings; and notify the volunteer coordinator if you cannot complete an assignment. • Set a good example for the athlete: Refrain from smoking, consuming alcohol or using profanity as a volunteer; be discreet in your personal relationships with athletes and avoid any behavior which may be misunderstood or misinterpreted; and be helpful to and supportive of everyone associated with Special Olympics. • Demonstrate good sportsmanship and cooperation: Support the decisions of referees, judges, and committees, and use proper dissent processes; be respectful during ceremonies; praise the athletes for their efforts and encourage them to be happy for the success of other athletes; and support and encourage other volunteers and staff. • Be vigilant and aware of the safety of the athlete: Never leave an athlete unchaperoned; report anything you observe, either in the physical environment or in an individual’s behavior, which you feel may cause potential harm. • Be loyal to your commitment to Special Olympics: Look for constructive ways to overcome obstacles. • Take advantage of the opportunities Special Olympics offers you: Be open to new ideas and new ways of doing things; become an active participant by extending your involvement to other roles of leadership and training; and delight in the change your involvement makes in the life of someone you know and in the many lives of those you’ll never meet.
Please read the following before signing
Over the course of volunteering for Special Olympics Colorado, I may become aware of personal information, and I agree to keep said information in the strictest confidence.
I grant Special Olympics Colorado permission to use my likeness, voice and words in television, radio, film or any form to promote activities of Special Olympics and its mission.
I understand that the relationship between Special Olympics Colorado and volunteers is an “at will” arrangement and that it may be terminated at any time, without cause, by either the volunteer or Special Olympics Colorado.
I have read this ‘Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement’ and fully understand it. I affirm that I have read all pages of this Application and understand its meaning. I also affirm the information I have given is true and complete. Applicant Signature:__________________________________ Print Name: ____________________________Date:_____________
Please return all completed applications to Special Olympics Colorado
Attn: Katie Roche 384 Inverness Parkway, Suite 100
Englewood, CO 80112 Or [email protected]
Office Use Only
Date Received: _________________
Region: MH DM West NE SE
Accepted or Rejected
Staff:___________ Date:________
Office Use Only
Application
Photo ID
Protective Behaviors Quiz
Background Check
6-33
32
Special Olympics Colorado Class “A” Minor Volunteer Reference Form This page is to be completed if you qualify for one or more of the following:
17 years of age or younger Unified Partner participating in a school program 18 years of age and a student participating in a school program
MINOR VOLUNTEER INFORMATION
In consideration of participating with Special Olympics Colorado, I affirm that both references listed below are:
1) true and complete 2) are from personal, professional, or scholastic relationships, and 3) do not include family members.
_____________________________________________________________________ _____________________ Print Name of Minor Volunteer Date of Birth _____________________________________________________________________ ______________________ Signature of Minor Volunteer Date _____________________________________________________________________ Print Name of Parent or Guardian _____________________________________________________________________ ______________________ Signature of Parent or Guardian Date
PERSONAL/PROFESSIONAL REFERENCE #1
Name:
Relationship to Minor: Address:
Email Address:
Day Phone: ( )
Night Phone: ( )
How long have you known the reference? ____________Years _____________ Months
SCHOLASTIC/EDUCATIONAL REFERENCE #2
Name:
Relationship to Minor:
Address:
Email Address:
Day Phone: ( )
Night Phone: ( )
How long have you known the reference? ____________Years _____________ Months
6-34