The version of the browser you are using is no longer supported. Please upgrade to a supported browser.Dismiss

Untitled form
Send
Untitled form
Section 1 of 1
Question
Question Type
Loading image...
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Female
Male
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Less than one year
1 year
2 years
3 years
4+ years
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Local Disc Organization Email
Local Disc Organization Facebook
Local Disc Organization Twitter
Local Disc Organization Website
Paid Facebook Ad
USA Ultimate Facebook
USA Ultimate Twitter
USA Ultimate Website
Word of Mouth
School
Other…
Add option
Answer key
(0 points)
Loading...
Loading...
Question
Question Type
Loading image...
Yes
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading...
Title
Loading...
Loading...
Loading image...
Loading...
Loading...
Title
Loading...
Loading...
Loading image...
Loading...
Loading...
Message for respondents
This form is no longer accepting responses
Insights
Total points distribution
Loading...
Loading responses...
What is the clinic participant's first and last name?
No responses yet for this question.
What is the participant's date of birth?
No responses yet for this question.
What is the participant's gender?
No responses yet for this question.
What is the participant's street address?
No responses yet for this question.
What is the participant's city, state and zip code?
No responses yet for this question.
What is the participant's approximate projected high school graduation date (month/year)?
No responses yet for this question.
What is the name of the school the clinic participant attends?
No responses yet for this question.
What is the parent or guardian's first and last name?
No responses yet for this question.
What is the parent or guardian's email address?
No responses yet for this question.
What is the parent or guardian's phone number?
No responses yet for this question.
What is the clinic participant's experience with ultimate?
No responses yet for this question.
How did you hear about this Learn to Play Clinic?
No responses yet for this question.
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to indemnify and hold harmless the releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs above, even if arising from their negligence, to the fullest extent permitted by law.
No responses yet for this question.
View USA Ultimate waiver by clicking on the below link.
Remember to print and bring the USA Ultimate Medical Authorization form to the clinic.
of
17
Main menu
.