2019 Music City Polar Plunge Class B Volunteer Registration Form


Minors without valid Photo IDs must be vouched for by accompanying adult. Volunteers under 15 years of age must be accompanied by an adult. No volunteers under 13 years of age.

First Name *
Your answer
Last Name *
Your answer
Address 1 *
Your answer
Address 2
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
E-mail *
Your answer
Phone Number *
Your answer
In Case of Emergency *
Your answer
Phone Number *
Your answer
Date of Birth (Volunteers under 15 must be accompanied by an adult. No volunteers under 13.) *
Shirt Size *
Please select a preferred volunteer area. *
Are you with an organization? *
Your answer
Do you have any physical or medical limitations that would impact your ability to volunteer? *
Note: this is to help determine suitability for volunteers roles, as available. All applicant-provided information will be kept confidential.
If "yes," to above, please briefly describe nature of physical or medical limitations that would effect your ability to volunteer in certain roles?
Your answer
Volunteer Code of Conduct
- 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 dress and act at all times in a manner which will be appropriate to my assigned responsibilities and a credit to myself, the athletes and Special Olympics.
- I will display control, respect, dignity and professionalism to all involved including athletes, coaches, opponents, officials, administrators, parents, spectators and media. Profanity and taunting are subject to immediate ejection.
- I will provide for the general welfare, health, and safety of any Special Olympics athlete(s) in my charge during the course of my assigned duties.
- I will respect the property of hotels, dormitories, schools, athletic, recreational and dining facilities.
- I will report any emergencies to the appropriate authorities after first taking immediate action to ensure the health and safety of the participants.
- I will not take part in the consumption of alcoholic beverages and/or controlled substances during any Special Olympics training or competition. Nor will I take part in smoking or chewing tobacco at any Special Olympics training or competition site except in designated areas.
- I will not engage in any type of inappropriate behavior, sexual activity, and/or verbal or physical abuse with Special Olympics athletes, staff, officials or other volunteers.
- I will abide by the Special Olympics policy on the prohibition of dating athletes.
The Code of Conduct is designed to assist each volunteer in abiding by the philosophy of Special Olympics and its mission. Any volunteer who does not follow this Code of Conduct can be prohibited from participation in this event.
I acknowledge that I have read the Volunteer Code of Conduct and agree to adhere to said terms. *
Terms and Conditions
I agree to the following:

1. Ability to Participate. I am physically able to take part in Special Olympics activities. I know there is a risk of injury.

2. Likeness Release. I give permission to Special Olympics, Inc., Special Olympics games/local organizing committees, and Special Olympics accredited Programs (collectively “Special Olympics”) and Special Olympics partners and sponsors to use my likeness, photo, video, name, voice, words, and biographical information to promote Special Olympics, raise funds for Special Olympics, and acknowledge partners’ and sponsors’ support for Special Olympics.

3. Emergency Care. If I am unable, or my guardian is unavailable, to consent or make medical decisions in an emergency, I authorize Special Olympics to seek medical care on my behalf.

4. Personal Information. I understand that Special Olympics will be collecting my personal information as part of my participation, including my name, image, address, telephone number, health information, and other personally identifying and health related information I provide to Special Olympics (“personal information”).

I agree and consent to Special Olympics:

using my personal information in order to: make sure I am eligible and can participate safely; run trainings and events; share competition results (including on the Web and in news media); provide health treatment if I participate in a health program; analyze data for the purposes of improving programming and identifying and responding to the needs of Special Olympics participants; perform computer operations, quality assurance, testing, and other related activities; and provide event-related services.
using my personal information and creating a profile of me for communications and marketing purposes, including direct digital marketing through email, text message, social media, and other channels.
sharing my personal information with (i) medical professionals in an emergency, and (ii) government authorities for any purpose necessary to protect public safety, respond to government requests, and report information as required by law.

I understand Special Olympics is a global organization with headquarters in the United States of America. I acknowledge that my personal information may be stored and processed in countries outside my country of residence, including the United States. Such countries may not have the same level of personal data protection as my country of residence, and I agree that the laws of the United States will govern your processing of my personal information as provided in this consent.

I have the right to ask to see my personal information or to be informed about the personal information that is processed about me. I have the right to ask to correct and delete my personal information, and to restrict the processing of my personal information if it is inconsistent with this consent.

Privacy Policy. Personal information may be used and shared consistent with this form and as further explained in the Special Olympics privacy policy at www.SpecialOlympics.org/Privacy-Policy.aspx.

5. Waiver and Liability Release. I understand the risks involved with participation in Special Olympics activities. I fully accept and assume all such risks and all responsibility for losses, costs, and damages I may incur as a result of my participation. I hereby release and agree not to sue any Special Olympics organization, its directors, agents, volunteers, and employees, and other participants (“Releasees”) related to any liabilities, claims, or losses on my account caused or alleged to be caused in whole or in part by the Releasees. I further agree that if, despite this release, I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify and hold harmless each of the Releasees from any such liabilities, claims, or losses as the result of such claim. I agree that if any part of this form is held to be invalid, the other parts shall continue in full force and effect.

On behalf of myself and/or my minor child, I acknowledge that I have thoroughly reviewed and agree to to said terms and conditions. *
Full Name of Volunteer (serving as electronic signature) *
Your answer
Full Name of Parent or Guardian, if Volunteer is a Minor (serving as electronic signature). I have explained this form to minor volunteer.
Your answer
Parent/Guardian Cell Phone #, if Volunteer is a Minor
Your answer
Date (serving as electronic signature) *
Your answer
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