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Paratriathlon Introductory Questionnaire
Please complete the questionnaire to the best of your ability so we can learn more about you and add you to our monthly USA Paratriathlon Bulletin email to stay connected.
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First name
Your answer
Last name
Your answer
Yo
ur email address
Your answer
What is the best phone number to reach you?
Your answer
Gender
Female
Male
Other:
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City, State
Your answer
Date of birth?
MM
/
DD
/
YYYY
Would you like to be added to the monthly USA Paratriathlon Newsletter?
Yes
Clear selection
Describe your impairment.
Your answer
To the best of your knowledge, what Paratriathlon category do you believe you fall into?
PTWC - Handcycle: Paraplegic, Quadriplegic, Polio, Double Amputee
PT2 - Severe Leg Impairment: Above-knee amputees
PT3 - Les Autres: Includes athletes with Multiple Sclerosis, Muscular Dystrophy, Cerebral Palsy, Double Leg Amputee (runners) or Paralysis in multiple limbs
PT4 - Arm Impairment: Including above and below elbow amputees or impairment in one or both upper limbs
PT5 - Moderate Leg Impairment: Below-knee amputees
PTVI - Visual Impairment: Legally Blind
ATD2 - Neuro Diverse (Down Syndrome, Autism, ect.)
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Have you been classified in another Paralympic Sport?
Yes
No
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If so, which sport(s)?
Your answer
Have you ever completed a triathlon/duathlon?
Yes
No
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What other sports have you competed in since your injury or impairment?
Your answer
Name your current triathlon coach.
Your answer
How much time do you dedicate to training per week?
Your answer
What are your short term Paratriathlon goals?
Your answer
What are your long term Paratriathlon goals?
Your answer
Do you have your own Paratriathlon equipment?
Your answer
What equipment do you not have?
Your answer
Are you currently, or have been in the past, a member of the United States Armed Forces?
Yes
No
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Give us a sense of your day-to-day life -- are you in college or working?
Your answer
Are you currently competing competitively in any other Paralympic Sport?
Yes
No
Clear selection
Why are you interested in competing in Paratriathlon?
Your answer
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