Program Registration
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
* Required
Email address
*
Your 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
*
Your answer
Last Name
*
Your answer
Gender
*
Your answer
Age
*
Your answer
Ethnicity
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Choose
White/Caucasian
Hispanic/Latino
Native American
Black or African American
Asian
Native Hawaiian or Other Pacific Islander
Middle Eastern
Prefer not to answer
Other
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
County
*
Your answer
Disability/Diagnosis
*
Your answer
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
Parent/Guardian Information
First Name
*
Your answer
Last Name
*
Your answer
Email
*
Your answer
Phone (Primary)
*
Your answer
Phone (Secondary)
Your answer
Family Size
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
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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