Request edit access
Wheelchair Rugby Clinic
Complete this form to RSVP for the Wheelchair Rugby Clinic.
* Required
Name of Athlete
*
Your answer
Email
*
Your answer
Phone number
*
Your answer
Athlete's Disability
*
Choose
Arthrogryprosis
Cerebral Palsy
Dwarfism
Intellectual Disability
Amputee
Muscular Dystrophy
Other
Spina Bifida
Spinal Cord Injury
TBI/Stroke
Transverse Myelitis
Visual Impairment/Blind
Age
*
Your answer
Gender
*
Male
Female
Width of Hips (Current wheelchair seat width or place a book, standing on it's end, on either side of your hips and measure from inside cover to inside cover)
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Adaptive Sports Program of Ohio.
Report Abuse
Forms
