Adaptive Sports Association Participant Intake
Winter 2018-19
First name:
Your answer
Last name:
Your answer
Emergency contact- full name, relationship, phone no. *
Your answer
Date of birth:
MM
/
DD
/
YYYY
Street address:
Your answer
City:
Your answer
State:
Your answer
Zip code:
Your answer
Dates of ski lesson
Your answer
Cell phone:
XXX-XXX-XXXX
Your answer
Home phone:
XXX-XXX-XXXX
Your answer
Work phone:
XXX-XXX-XXXX
Your answer
E-mail:
Your answer
Gender:
Age:
Your answer
Height:
Your answer
Weight:
Your answer
Shoe size:
Your answer
Are you your own legal guardian? *
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