2022 Allegheny River Rumble Registration Form

Email *

example@example.com

Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Please enter a valid phone number.

Date of Birth *

Gender *

Female Male

Personal Information (please be as specific as possible):

Disability: *

Date of Onset: *

Height *

Weight *

Skiers must be 200lbs or less and must be able to fit into an 18" wide wheelchair.

If your main mode of mobility is walking and you use any assistive device, please note it here. *

If you use a wheelchair, is it manual or motorized? *

If face down in the water wearing a life-preserver are you able to roll onto your back independently (this is mandatory and you will have to pass a roll test prior to skiing)?

Are you able to perform the roll-over maneuver? *

Yes No

Previous water ski experience and equipment used (since onset of your disability) *

List other sports you participate in on a regular basis. *

Are you currently under a doctor's care for any condition? If yes, please explain. *

Are you allergic to anything [i.e. food, sun, medication]? If yes, please explain. *

Do you need to limit your activities for any reason? If yes, please explain. *

Do you have seizures? *

Yes No

Within the past six months, have you had any injury to, or surgery on your back, spinal cord, or hips? If yes, please explain. *

Do you wear a back brace or have Harrington Rods? If yes, please describe. *

Are there any other special medical conditions TRAS should know about (asthma, diabetes, heart trouble, etc.)? If yes, please explain. *

List medications you are currently taking: *

Provide an Emergency Contact Name, Phone number, and Relationship to you. *

Registration Deadline is August 7, 2022.

This includes Registration and Waiver Forms.

Carry the signed GTWSC Waiver Form with you to the event.