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ADAPTIVE SKI ASSOCIATION OF WEST MICHIGAN
"If I can do this, I can do anything!"
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Athlete Information
First name
*
Last name
*
Athlete Date of Birth
*
Month
Month
Day
Year
Athlete Height
*
Athlete Weight in pounds
*
175 pound weight limit
Athlete Phone Number
*
Athlete Email
*
Athlete Address
*
Parent/Guardian Name
*
Parent/Guardian Phone Number
*
Parent/Guardian Email
*
Parent/Guardian Address
*
Emergency Contact Name
*
Emergency Contact Phone
*
Experience
Prior experience as an athlete with our program?
Yes
No
Please indicate your past adaptive ski experience
Bi-Ski
Mono-Ski
Stand Up
Ski Slider
Snowboard
None
Disability
Please describe the athlete's disability for equipment and matching purposes.
Please describe any medical precautions
Describe behavioral issues, if any, that volunteers should be aware of.
Does the athlete need bathroom assistance?
Yes
No
Program Preference
First Preference
Tuesday 6-8p
Wednesday 6-8p
Thursday 6-8p
Sunday 1-3p
Sunday 2-4p
Sunday 3-5p
Second Preference
Tuesday 6-8p
Wednesday 6-8p
Thursday 6-8p
Sunday 1-3p
Sunday 2-4p
Sunday 3-5p
Third Preference
Tuesday 6-8p
Wednesday 6-8p
Thursday 6-8p
Sunday 1-3p
Sunday 2-4p
Sunday 3-5p
Preferred Volunteer(s) for Lessons
If the athlete is a stand up skier, are rental skis needed?
N/A (sit skier)
Yes
No
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