Ski/Board Lesson Request & Registration

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We are eager to have you on the mountain, our Winter Lesson Coordinator will be confirming your lesson request.

Questions? Feel free to call (208) 315-4275 or wintercoordinator@awesomemccall.org

All of our instructors are trained, high caliber Volunteers.

RESERVATIONS ARE REQUIRED at least 48 hours in advance, if you request a lesson day outside of our schedule we will do our best to accommodate. Please schedule lessons as far in advance as is possible.

Email *

Today's Date *

YYYY

Participant's First & Last Name *

Parent or Guardian (if participant is under 21)

Participant's Date of Birth *

YYYY

Participant's Gender *

Female

Male

Prefer not to say

Other:

Participant's Height (ft - in) *

Participant's Weight (lbs) *

Mailing Address *

City *

State *

Zip Code *

Telephone Number *

Emergency Contact Name and Number *

Emergency Contact's Relationship to Participant *

Physician and Contact Number *

What is your general physical condition

Excellent

Good

Fair

Required

What is your disability? Please be as detailed as possible. *

If spinal cord injury, level of injury:

Are you able to walk? *

Yes

Other:

Do you use a mobility assistance device? *

Yes

Other:

If yes, which type?

Are you able to walk up and down stairs? *

Yes

Other:

If you use a wheelchair, are you independent with your transfers?

Yes

Other:

Clear selection

Do you have a visual impairment? *

Yes

If so, please describe the severity/type:

Do you have a hearing impairment? *

Yes

If yes, please describe the severity/type:

Do you wear any sort of spinal stabilization? *

Yes

If so, please describe:

Due to your injury, are any areas of your body susceptible to impact/heat/cold? *

If yes, please describe:

Please describe any cardiac problems you have:

Do you have a history of seizures? *

Yes

Other:

Are seizures controlled by medication?

Yes

Other:

Clear selection

Have you had a seizure in the last 2 years?
*

Yes

Other:

Date of Last Seizure

YYYY

Are there any special instructions relative to seizures?

Have you had surgery in the last 6 months? *

Yes

Other:

Are you currently taking any medications (Please list them below)? *

Do you have any bowel or bladder adaptations? *

Are there any behavioral problems? *

Please describe any other medical conditions/allergies/sensitivities: *

Which lesson type would you like?: PLEASE NOTE: You must be cleared by your physician for the sport you’re participating in. *

Alpine (downhill) Ski

Snowboard

Nordic (Cross Country)

Other:

Required

Have you skied/snowboarded before? *

Yes

Other:

If previous skiing/snowboarding experience, adaptive equipment used:

Have you skied/snowboarded since your injury/disability onset? *

Yes

N/A (such as disability from birth)

Other:

Last approximate date skied/snowboarded: *

I would rate my skiing or snowboarding ability as: *

Beginner

Advanced

Type of Terrain Skied/Riden: *

Green (beginner)

Blue (intermediate)

Black (expert)

Bumps

Required

Your goals for your skiing/snowboarding experience:

Requested Lesson Dates *

Tell us about you - It is helpful to know any other specifics about peoples' disabilities, anything we should be aware of, etc. *

Instructor Request (optional)

Person completing questionnaire: *

Relationship to Participant: *

How did you hear about AWeSOMe!? *

A copy of your responses will be emailed to the address you provided.

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