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Clinics Request Form
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* Indicates required question
School Name
*
Your answer
Location
*
Your answer
Address
*
Your answer
Contact Name
*
Your answer
Contact Email
*
Your answer
Sport requesting
*
Wheelchair Basketball
Sledge Hockey (wheeled)
Sledge Hockey (ice) - this is limited in availability, please email to inquire
Time requesting
*
Full day ($300)
Half day ($150)
Partial day (contact for pricing)
Date or days requesting
*
Your answer
Start Time and End Time
*
Your answer
Do you have a student with a disability that will be participating in this clinic?
*
Yes
No
Any additional information?
Your answer
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