Adaptive Lesson Inquiry
Email Address *
Your answer
First and Last Name of Participant *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Your Name (if different)
Your answer
Phone Number *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code
Your answer
Discipline *
Lesson Date *
MM
/
DD
/
YYYY
Height
Your answer
Weight
Your answer
Shoe Size
Your answer
Description of Adaptive need *
Your answer
Other related medical or recent surgery we should be aware of
Your answer
Medications (if relevant)
Your answer
Previous Snowsports or Other Recreational Activity
Your answer
Skiing/Riding Goals
Your answer
Instructor Request
Your answer
If requested instructor is unavailable, are you okay with a different instructor?
Best time to contact you?
Other Comments
Your answer
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