2022 TRAS Water Sports Clinic Participant Registration
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Email *
First Name *
Last Name *
Street Address *
City *
State *
Zip Code *
Phone Number *
Date of Birth *
Emergency  Contact Name *
Emergency Contact Phone Number *
T-Shirt Size *
Will you be planning to kayak? *
WATER SKI OPTIONS [FULL DAY LIMIT 2 DAYS ONLY]
Monday 11th? *
Required
Tuesday 12th? *
Required
Wednesday 13th? *
Required
Thursday 14th? *
Required
If more days become available do you want to be considered? *
Nature of Disability *
Date of onset of Disability *
NOTE: Skiers must weigh LESS than 200lbs and fit an 18" wide wheelchair.
Height *
Weight *
Choose your most frequent mode of mobility: *
Required
If face down in the water wearing a life-preserver, are you able to roll onto your back independently (this is mandatory and you will have to pass a roll test prior to skiing)? *
Previous water ski experience and equipment used (since disability): *
Other sports you participate in on a regular basis: *
Are you currently under a doctor’s care for any condition? (if yes, explain): * *
Are you allergic to anything? (i.e., medication, food, sun) (if yes, explain): *
Do you need to limit your activities for any reason? (if yes, explain): * *
Do you have seizures? *
Within the past six months, have you had any injury to, or surgery on your back, spinal cord, or hips? *
Do you wear a back brace or have Harrington Rods? Yes or No (If YES, describe) *
Are there any special medical conditions the staff should know about (asthma, diabetes, heart trouble, etc.)? Yes or No (If Yes, explain): *
List all medications you are currently taking: *
Please complete this form and pay your registration fee to "THREE RIVERS ADAPTIVE SPORTS" by July 5, 2022 *
TRAS Annual Membership Fees: Individual = $20 / Family = $30
How will you be paying your participation fees? *
Make checks payable to: Three Rivers Adaptive Sports                                                                                                                                              
Mail to: Marcia Logan - 5 Canterbury Road - Pittsburgh PA 15202
If using PayPal, please provide the Name of the person making the payment.
Comments or Questions:
We look forward to seeing you there! Remember to make your PAYMENT!
A copy of your responses will be emailed to the address you provided.
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