Wasatch Adaptive Sports Student Registration Form 2018
Thank you for your interest in participating with Wasatch Adaptive Sports! Please submit the information below to begin the registration process. After submitting, we will contact you to complete final paperwork and schedule your lesson. If you have any questions or require assistance, please call 801.933.2188 or email
For students under the age of 18, please provide address, phone and email of parent/ guardian.
Student First Name
Student Last Name
Parent/ Guardian First and Last Name (if child under the age of 18)
Date of Birth
Race or Origin
Black or African American
Hispanic, Latino, or Spanish
Middle Eastern or North African
Native American or Alaska Native
Native Hawaiian or Native Pacific Islander
Prefer Not to Specify
Amputation or Limb Deficiency
Spinal Cord Injury
Other Neurological Diagnosis
Are you a veteran of the U.S. Armed Forces?
What are your goals in participating in WAS activities? Select all that apply.
Get exercise or be active
Improve strength, range of motion, flexibility, etc.
Learn the skills of recreation
Be social or be a part of a community
Improve mental health
If your goal(s) include something other that what is listed above, please describe below.
How did you hear about WAS?
Referral from health care provider, hospital or rehabilitation facility
Referral from family or friend
Conference or outreach event
Internet/ social media
WAS or Snowbird employee or volunteer
Notice of Nondiscrimination Policy to Students
Wasatch Adaptive Sports does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admission policies, scholarship and athletic and other administered programs.
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