2025 TRAS Snow Ski Program Participant Information Form

2025 TRAS Snow Ski Program Participant Information Form

Complete once for the 2025 season.
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone *
Please enter a valid phone number.
Cell Phone*
Please enter a valid phone number.
List EMERGENCY CONTACTS including name, phone number and relationship.*
Date of Birth*
Age*
Height & Weight*
Primary Disability & Date of Onset*
Secondary Disability if applicable. Please provide details.
What is your primary means of mobility?*
Please provide specific details of assistive devices used including braces, AFO's, etc.
Do you need assistance for transfers?*

YesNo
If yes, please provide details.
Do you have any of the following conditions?*

AsthmaDiabetesHigh Blood PressureLow Blood PressureHepatitisAutonomic DysreflexiaHIV/AIDSBladder Drainage DeviceNone
Do you have any allergies [food, medications, etc]?*
Do you have a history of seizures? If yes, please explain. Include type, frequency, date of last seizure. Do you know when you are going to have a seizure?*
Do you wear glasses?*

YesNo
Have you had any surgeries in the past? If yes, specify.*
Are you currently under a doctor's care? If yes, specify.*
Do you need to limit your activities for any reason? If yes, specify.*
List all medications you are taking including dose, reason, and side effects.*
Please provide any/all additional information about your functional ability that you feel your ski instructor should know about in order to make your skiing experience as safe and successful as possible: *
Do you have a Spinal Cord Injury?*

YesNo

END SCI
Have you ever skied or snowboarded before?*

YesNo

END SECTION
Have you participated in an adaptive ski program before?*

YesNo

END SKI METHOD
NOTE: ALL SKIERS/SNOWBOARDERS PARTICPATING IN THE THREE RIVERS ADAPTIVE SPORTS SKI PROGRAM ARE REQUIRED TO WEAR A HELMET

ALL sit down skiers MUST have a lift retention strap and emergency evacuation system attached to their sit down ski unit.
By signing below, I verify that the above information is current and accurate. I understand that the information above is confidential and will only be used by the instructor and volunteers to provide the student with a safe and enjoyable skiing experience.
Participant's Signature*

Clear
Parent/Guardian Name if Participant is a MINOR.
Parent/Guardian Signature

Clear
Clicking the 'Submit' button will take you to the Liability Release Form.
“If I can do this, I can do anything”

Three Rivers Adaptive Sports P.O. Box 38235 Pittsburgh, PA 15238 (412) 848-8896 www.traspa.org
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