Summit Adaptive Sports Participant Form

Welcome to Summit Adaptive Sports!

Participating in sports provides lifelong opportunities for physical and mental development as well as opportunities for individual accomplishment and inclusive family activities. Summit Adaptive Sports provides access and instruction in outdoor sports to individuals with developmental or acquired disabilities.

For more information on our organization, programs, and frequently asked questions please visit our website at summitadaptive.org. If you still have questions, please email us at summitadaptivesports@gmail.com.

Steps to Register:

Step 1: Complete the questionnaire below so that we can learn more about you (or your family member) and your interests so that we may best plan your lesson(s) experience.

Step 2: Once we receive your completed questionnaire you will receive a confirmation /thank you page with links to our waivers to be signed electronically. Please allow 3 business days for us to process your registration.

Please Note: If you are skiing or snowboarding during the winter you will need to contact Ski Sundown Welcome Center directly at (860)379-7669 ext. 211 to book and pay for your lessons once you submit this registration. Filling out this registration alone does not secure your lesson or program reservation.

Medical Information
Primary Diagnosis*
Secondary Diagnosis if applicable
Please provide any additional information that may be helpful. If you have an acquired disability please tell us the date of injury or initial onset.
Do you have allergies?:*

YesNo
Please describe the allergies:*
(For example: severe nut allergy, seasonal, pollen, medication etc..)
Do you carry an Epi Pen, and where is it located when you are participating in sports? *
(If you do not carry an Epi Pen, please write N/A or No in this section.)
Do you have seizures currently or is there a history of seizures?*

YesNo
Please describe type and frequency of seizures.*
Upload Physician Seizure form if available. If not available, please send to us at summitadaptivesports@gmail.com at least two weeks prior to your first scheduled activity.

Cancelof
Please list any medications currently taking that could have an effect on the lesson:
(For example: make drowsy, frequent bathroom needs, sensitive to sun, etc..)