2024 Allegheny River Rumble PARTICIPANT Registration Form

2024 Allegheny River Rumble PARTICIPANT Registration Form
Participant Type*
Participant Sub-type*
Branch of Service*
Rank
Last Name*
First Name*
Birth Date*

MonthDayYear
Date
Disability Type*
Disability Sub-Type*
Date of Injury

MonthDayYear
Date
Place of Injury
Gender*
LGBTQ*
Race*
Hispanic, Latino or Spanish Origin*
Address*
City*
State*
Zip*
Cell Phone*
Home Phone*
E-mail*
Height*
Weight*
Skiers must be 200lbs or less and must be able to fit into an 18" wide wheelchair.
Choose your most frequent mode of mobility:*

WalkingWalking with an Assistive DeviceManual WheelchairElectric Wheelchair or ScooterOther
If 'Other' please specify.
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?*

YesNo
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?*

YesNo
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 4, 2024.

This includes Registration and Waiver Forms.

Carry the signed GTWSC Waiver Form with you to the event.
By Clicking 'Submit' you will be taken to the required TRAS Liability Waiver Form.
Should be Empty: