Paddling Participant Registration Form 2023

Email

example@example.com

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date of Birth

Gender

I want to register for the following TRAS Paddling Series date(s):

I Prefer to:

NOTE: Registration, Fees and TRAS & Hazelbaker’s Liability Releases Must Be Received ONE WEEK prior to selected date(s) above.

Personal Information (please be as specific as possible):

Disability:

Date of Onset:

Height

Weight

Paddlers must be 210lbs 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?

Any previous kayak/canoe experience and equipment used (since disability):

Are you able to swim?

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?

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 one week in advance of selected date(s)

I will pay my fee [$10 TRAS Member, $15 Non-Member] Per Paddler

Mail Checks to: TRAS P.O. Box 38235, Pittsburgh, PA 15238

When you click 'Submit' you will return to the Paddling webpage.