Program Registration

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Zia Freewheelers Adaptive Cycling Team
Alameda Open Space

CTHF Wheel Runners - Wheelchair Basketball Team
JCC Albuquerque: 5520 Wyoming Boulevard NE, Albuquerque, NM 87109

New Mexico Blade Runners Adaptive Sled Hockey
Outpost Ice Arena: 9530 Tramway Blvd NE, Albuquerque, NM 87122

Email *

Select a program you wish to register for: *

Zia Freewheelers Adaptive Cycling Team

CTHF Wheel Runners - Wheelchair Basketball Team

New Mexico Blade Runners Adaptive Sled Hockey

First Name *

Last Name *

Gender *

Age *

Ethnicity *

Street Address *

City *

State *

Zip Code *

County *

Disability/Diagnosis *

My child has participated in this program for (dropdown list of 1 – 5+ years)

1 year

2 years

3 years

4 years

5+ years

Never Attended

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Parent/Guardian Information

First Name *

Last Name *

Email *

Phone (Primary) *

Phone (Secondary)

Family Size *

Emergency Contact Name *

Emergency Contact Phone Number *

CTHF Release & Waiver Of Liability Form - View the form at: https://www.carrietingleyhospitalfoundation.org/wp-content/uploads/2020/02/CTHF-Release-Waiver-of-Liability-Form.pdf *

I agree to the form

Required

CTHF Photo Release Form - View the form at https://www.carrietingleyhospitalfoundation.org/wp-content/uploads/2020/02/CTHF-Photo-Consent-Release-Form.pdf *

I agree to the Photo Release Waiver

Required

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