New Participant Registration

New Participant Registration

Please fill in this form to register as a new participant for any Seattle Adaptive Sports Programs. If you have registered as a participant with Seattle Adaptive Sports in the past, please fill in the returning participant registration.
Name*

First NameLast Name
Email*
example@example.com
Nickname
Gender Identity*

FemaleMaleNon BinaryPrefer Not to AnswerOther
Person completing this form*

Adult Athlete (Age 18+)Minor Athlete (under age 18)Parent/Guardian of Minor AthleteOther
Participant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Date of Birth*
Ethnicity*

African American / BlackAmerican Indian / Alaska NativeAsianHispanic / LatinoMiddle EasternWhitePrefer Not to Answer
Primary language spoken at home
Education and Employment

Your responses help us get to know our membership base. Please complete the fields that apply to you.
Are you/the participant a student?

YesNo
Name of School/Grade Level
Are you/the participant employed?

YesNo
Participant's employer/occupation
Employer location
Example: Seattle, WA
Does your employer have charity matching?

YesNoI don't know/I'll find out
Does your employer have a volunteer program?

YesNoI don't know/I'll find out
What is your total annual income?*

$0-$30,000$31,000-$60,000$61,000-$90,000$91,000-$120,000$120,000+Prefer not to share
Are you a Veteran?*

YesNoPrefer not to share
If yes, what branch of service?
Athlete Disability Information

All responses are confidential
All athletes to complete the Travel Medical Form

The form is only seen by your coach and/or the volunteer medical staff member for your team and will only be given to emergency medical personnel in the event of emergency care being needed.

Parent/Guardian signatures and permissions will be given for minor athletes (under 18).
Please submit a travel medical form at this link: https://hipaa.jotform.com/220314796746058 Please type your full name to acknowledge that you have turned this form in.*
The form is only seen by your coach or the volunteer medical staff member for your team and will only be given to emergency medical personnel in the event of emergency care being needed. Parent/Guardian signatures and permissions will be given for minor athletes (under 18).
What is your primary disability?*
Disability Origin*

AcquiredBirthNo Disability
If acquired, what is your date of disability?
Are your immunizations up to date?*

YesNoOther
Please describe any other necessary medical information we should be aware of for your safe participation. This can include secondary disabilities, back fusions, having a shunt, conditions exacerbated by physical activity, recent surgeries, etc. *
If none, please type N/A
Do you transfer?*

I can transfer independentlyI need some assistanceI need full assistanceOther
Do you have any problems with?*

OverheatingDysreflexiaSpasticityPainNoneOther
Are any of these problems made worse by exercise or activity?

YesNo
What sports would you like to participate in?*

Wheelchair BasketballSled HockeyPower SoccerGoalball
Your sports classification (if known)
Any other information you would like us to know?
Waivers

Please review and sign the following waivers:
Move United (ALL PARTICIPANTS)

Seattle Adaptive Sports Participant
Policy Forms

Please review the following SAS Policies:
Team Policies

Participant Code of Conduct

Concussion Fact Sheet

Parental Code of Conduct

Equipment Loan Policy
My typed signature gives my acknowledgement of the Team Policies, Codes of Conduct and Concussion Fact Sheet. *
Please type your full name. If you prefer to upload hand signed documents, you can include it with the bottom question.
Permission is given to Seattle Adaptive Sports or competition organizing committee to seek medical care in case of emergency for the athlete named in this profile.*

YesNo
If you are borrowing equipment for the season, please complete and upload the Equipment Loan Policy form here and use the checkbox below to pay your season equipment loan fee.

Cancelof
My Products
prevnext( X )
Membership Fee
$75.00 Quantity

Equipment Loan Fee
$100.00 Quantity

Total

$0.00
Are you interested in volunteering for SAS?

YesNo
Do you have any awards or recognition?

YesNo
Tell us about any awards or recognition you have received.
Do you belong to any other groups or clubs?

YesNo
What groups or clubs to you belong to? (List any other groups or clubs you are a member of)

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

New Participant Registration

Education and Employment

Athlete Disability Information

Waivers

Policy Forms