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Participant interest form
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* Indicates required question
Last Name, First Name
Your answer
Phone Number
Your answer
What is your fitness goal?
Participate and train in sport
Build and maintain strength and endurance
Learn about sports nutrition
Learn about recovery and rehabilitation
Clear selection
Have you ever participated in adapted sports before?
Yes
No
Clear selection
Which sports and activities are you interested in?
Adapted Fitness & Rehabilitation
Adapted Sports (general)
Wheelchair Tennis
Wheelchair Basketball
Wheelchair Rugby
Seated Volleyball
Adapted Archery
Blind Soccer
Hand Cycle
Track & Field
Adapted Aquatics
Other:
Do you currently have any disabilities or mobility limitations?
*
Yes
No
What is your primary disability?
Your answer
If you have a mobility limitation not associated with a disability, what is the nature of the mobility limitation?
Your answer
Do you use any Mobility Aids or Assistive Devices? (wheelchair, walker, orthotic braces, hearing aids, visual aids, etc.)
Wheelchair
Walker
Visual Aid
Prosthetic
Orthotic Brace
Hearing Aid
Grip Support
None
Other:
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