Water Sports Registration Form
90 Housatonic Dr., Sandy Hook, CT 06482 t:(203)426-0666 lofskiers@gmail.com
Please complete registration by 3 PM the day prior to an event. For Monday events, please complete registration by 3 PM the Friday before.
Clinic Date
NOTE: If the clinic you wish to register for is not on this list, please contact the office regarding the registration process. For Burke Rehab Hospital, please contact Alexandra Oudheusden. For Helen Hayes Rehab Hospital, please contact Matthew Castelluccio.
Participant's Full Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Weight (approximate)
in pounds
Your answer
What is the participant's disability?
Please list any and all limitations that may prevent participant from partaking in a conventional waterski program.
Your answer
Full Address
address, city, state, zip code
Your answer
Email address
Please note that we send pertinent information via email. Please check your emails regularly to stay up to date.
Your answer
Phone number
Your answer
Are the email address and phone number provided for the participant or a caretaker?
In other words, with whom are we communicating when we send an email/make a phone call?
If answered "caretaker" to the question above, please list caretaker's name.
Your answer
Emergency contact information
Please provide a contact other than the parent/guardian(s) accompanying the participant to the event. Be sure to include the contact's name, relationship to the participant, and phone number.
Your answer
How many total people (family/caretaker/friends) are joining the participant on clinic day?
It is at the parent/guardian's discretion, based on the participant's maturity and energy level, if you would like to drop off/pick up the participant or if you would like to stay during an event. We ask for a $5 lunch donation from all family members who plan on joining the skier, if they intend to join us for lunch.
For new participants: how did you hear about LOF?
Your answer
Athlete's Authorization/Release of Liability. I know of no reason why my participation in these or any sporting events provided should be exceptionally or unusually hazardous. I have full considered the risk that I may be physically injured as I prepare and participate in these events and I assume such risk. I intend this to be a complete release and discharge of all persons as well as any corporate entities having anything to do with this event and I intend hereby to release and forever discharge said persons from all liability whatsoever. I have read all of the statements contained herein and I fully realize that I am signing complete release and bar to any further claims which I may have resulting from my participation in these events.
Electronic Signature (you agree your electronic signature is the legal equivalent of your manual signature)
Your answer
Deposit
A $30 deposit is required for this event. Your deposit will be fully refunded in full the day of the event. Make checks payable of LOF Adaptive Skiers and send along with this registration form to 90 Housatonic Dr., Sandy Hook CT 06482
Required
Cancellations
If it’s necessary to cancel your scheduled event we require that you give at least 48 hours notice. Water Sports Instruction is in high demand and your early cancellation will give another person an opportunity to learn to ski and advance in the sport. Please understand that if you do not give us 48 hours notice of your cancellation, your deposit will not be refunded.
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