Gateway Disabled Ski Program at Hidden Valley
Tell us about yourself!! (Athlete form)
Email address *
Hi! What is your name? *
Your answer
What is a good phone number to reach you at?
Your answer
Emergency Contact: *
Your answer
Emergency Contact phone number: *
Your answer
Is your emergency contact volunteering with you? *
Have you skied with any adaptive ski program at Hidden Valley or any other facility? *
What night will you be attending GDSP? *
Ski Equipment
If yes, please describe the equipment used. *
Your answer
Shoe size *
Your answer
Ski size
Your answer
Pole size
Your answer
Terrain skied upon
Adaptive Equipment used in the past:
Fixed Outriggers
Handheld outriggers
Medical Information
What are your disabilities? *
Your answer
Do you have implants (Pacemakers, etc.)? *
If yes, please list implants.
Your answer
Height *
Your answer
Weight *
Your answer
Are you currently under a doctor's care for any reason? *
Are you currently taking any medication(s) we should be aware of? *
Do you experience seizures? *
Are you currently taking any seizure medication? *
Do you have any dietary requirements and if so, please explain? *
Your answer
Are you ambulatory? *
If yes, what percent of the time, with what kind of aid?
Your answer
Do you need to limit your activities for any reason? *
Do you have any special medical conditions we should know about? (i.e. asthma, diabetes, heart troubles, etc.) Do you have any special medical instructions/information we should know?
Your answer
Goals for 2020 season *
Your answer
Any further comments and/or concerns for us at Gateway Disabled Ski Program?
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy