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NorCal SCI Handcycling Program (Able Bodied) Reservation Form
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* Indicates required question
Email
*
Your email
Participant Name
*
Your answer
Are you over 18?
*
Yes
No
Height
Your answer
Weight
Your answer
Have you handcycled before?
Yes
No
Maybe
Clear selection
Do you have one of the following disabilities?
Spinal Cord Injury (SCI)
Spina Bifida
Cerebral Palsy
Amputee
TBI
Blind/Visual
Multiple Sclerosis
Muscular Dystrophy
Other:
Clear selection
If SCI, what level?
Your answer
How good are your transfers?
Great, I can do a floor to chair transfer indepoendently
1
2
3
4
5
Not good, will likely need a Hoyer lift
Clear selection
What length ride are you interested in?
30 minute
1 hour
1.5 hours
4 hours
Clear selection
Do you have a friend or family member that could ride along and help?
Yes, I will have someone here to help who will bike with us
No I will come alone
Yes if that means I can have my lesson sooner
Clear selection
A copy of your responses will be emailed to the address you provided.
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