Fit Feet Screening Registration

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Email *

Gender *

Female

Male

First Name *

Last Name *

Address *

City *

State *

Zip *

County *

Phone *

Professional Role *

Affiliation *

Affiliation Name *

Malpractice Insurance *

Special Olympics offers coverage in North America thru a private insurance carrier. This coverage acts as a secondary coverage for health professionals who already have malpractice insurance. It will also act as primary malpractice insurance for health professionals who do not have malpractice insurance. In order to ensure that each volunteering clinician is covered both primarily or secondarily, we must know upon registration if you have coverage. If not, then Special Olympics Florida must send the names of those person to the insurance company prior to screening. You must also have a Florida license to practice in the state of Florida unless you are active duty in the military.

Yes, I have malpractice insurance

No, I do not have malpractice insurance

Volunteer Opportunity *

I am registering to be a screening volunteer

I am registering as a trained Clinical Director

Screening Event/Date *

Lunch will be served. Do you need a vegetarian option? *

T-Shirt Size *

Send me a copy of my responses.

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