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AARC Inclusive Erging 2024 Additional Athlete Information
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Email
*
Your email
Athletes Name
*
Your answer
Gender
*
Your answer
Date of Birth
*
Your answer
Parent/Guardian
*
Your answer
Emergency Contact Name & Phone
*
Your answer
Does the participant have a legal guardian or legal representative? If YES, the participant's legal guardian or legal representative must sign the waiver & release liability agreement on behalf of the participant.
*
Yes
No
Other:
Disability Evaluation: Please check all that apply.
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SCI Level: Complete
SCI Level: incomplete
AMPUTEE: Right
AMPUTEE: Left
AMPUTEE: Additional (place in additional comments below)
CVA/STROKE: R hemi
CVA/STROKE: L hemi
CVA/STROKE: Other (place in additional comments below)
CP TYPE: Pervasive
CP TYPE: Lower
CP TYPE: Single
CP TYPE: Cognition
CP TYPE: Hemi
CP TYPE: Upper
TBI: R Hemi
TBI: Cognition
DEVELOPMENTAL: ADHD
DEVELOPMENTAL: Autism S.D.
DEVELOPMENTAL: Down Syndrome
DEVELOPMENTAL: Intellectual
DEVELOPMENTAL: Other
VISUAL IMPAIRMENT: Partial
VISUAL IMPAIRMENT: Total
COMMUNICATION IMPAIRMENT
Other:
Required
Height & Weight
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Your answer
Any other comments you'd like to add?
Thank you so much!
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Your answer
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