Special Olympics Iowa Physical and Consent Form

Before athletes can begin competition in Special Olympics Iowa, they must submit a SOIA Physical and Consent Form, which includes:

  • Athlete Information, Health Insurance and Emergency Contact
  • Medical Clearance signed by a physician
  • Parent and/or Guardian Authorization and Media Release

This form must be renewed every three years, unless otherwise specified by your physician. A current Physical and Consent Form must be on file with the Special Olympics Iowa state office in order for an athlete to be eligible to practice and compete. This is the only physical form we can accept.

View SOIA Physical and Consent Form in Spanish

If you are unsure of the date your athlete’s Physical and Consent Form will expire, please contact:
Tanner Nissen, Information Manager — Games and Events
515-986-5520 x102

Athlete Information, Health Insurance and Emergency Information

These sections must be filled in completely.

Medical Clearance

The Medical Clearance section must be completed, signed and dated by a medical practitioner licensed to administer physical examinations by the state in which he/she practices. By signing the Medical Clearance, the medical practitioner is stating that the athlete is in good health and can safely participate in Special Olympics sports training and competition.

Parent/Guardian Authorization and Media Release

A parent or legal guardian must read, sign and date the Parent/Guardian Authorization and Media Release. This section must be signed and dated as printed.  Deletions or alterations to the section will result in an invalid application.

Only one of the two signature blocks must be completed.  Special Olympics Iowa operates under the understanding that this section may be signed by either:

  • The (biological or adoptive) parent unless the athlete has been designated a ward of the state; OR
  • The legal guardian (this person must be legally assigned for the individual); OR
  • The athlete if he/she is over the age of 18 and has not been designated as needing and having been assigned a legal guardian. A witness signature is required to verify that the athlete is his/her own legal guardian.

After Completing the Application

Make a copy of the Physical and Consent Form and send it to Special Olympics Iowa, PO Box 620, Grimes, Iowa 50111 or email physicals@soiowa.org. If the copy is not legible, we may ask for the original copy. In this case, please make sure to keep a copy for yourself. Once it is received, the state office will then validate the Physical and Consent Form.  A Physical and Consent Form will not be validated until all information is correct and completed on the approved form.

Special Olympics Iowa requires that all Physical and Consent Forms be presented prior to or at the time of the submission of the entry form for the event being entered.  All applications for the event in question must be valid throughout the completion of that competition.

Applications not on file or in receipt of by the specified deadline will not be accepted.