0925d Voluntary Service Application, National Veterans Wheelch

OMB Number: 2900-0759
Expiration Date: Xxx, 20XX
Respondent Burden: 20 minutes

2014 NATIONAL VETERANS
GOLDEN AGE GAMES
ATHLETE REGISTRATION CHECKLIST
REGISTRATION DEADLINE IS MARCH 28, 2014
NAME

ATHLETE FORMS
VA FORM 0925SF

REGISTRATION

VA FORM 0926d

WAIVER AND RELEASE OF LIABILITY

VA FORM 0926e

MEDICAL CLEARANCE INFORMATION

VA FORM 10-3203

CONSENT FOR USE OF PICTURE AND/OR VOICE

CURRENT EKG REPORT
CURRENT MEDICATION PROFILE

PLEASE ASK YOUR COACH OR MEDICAL CENTER STAFF TO REVIEW
THIS CHECKLIST WITH YOUR ATTACHED FORMS PRIOR TO MAILING.

Event rules and additional information can be found at:
www.veteransgoldenagegames.va.gov

REGISTRATION DEADLINE IS MARCH 28, 2014
PLEASE RETURN COMPLETED PACKETS TO:
Carol Kick
LOC Coordinator (135)
2014 National Veterans Golden Age Games
VA Medical Center
1100 N College Avenue
Fayetteville, AR 72703

VA FORM
FEB 2014

0926a