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2022 Adaptive Outdoor Family Fun Registration
Athlete registration must be completed by an adult 18 years or older.
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* Indicates required question
Participant First Name
*
Your answer
Participant Last Name
*
Your answer
Phone Number
*
Your answer
Email:
*
Your answer
Street Address:
*
Your answer
City:
*
Your answer
State:
*
Your answer
Zip Code:
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Disability:
*
Choose
Arthrogryposis
Cerebral Palsy
Dwarfism
Intellectual Impairment
Amputee
Muscular Dystrophy
Spina Bifida
Spinal Cord Injury
TBI/Stroke
Transverse Myelitis
VI/Blind
Other
If "other" disability, please explain:
Your answer
Date of injury (enter "birth" if congenital):
*
Your answer
Gender
*
Choose
Male
Female
Race
*
American Indian or Alaskan Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Other:
Military Veteran?
*
Yes
No
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