Advanced Recreation Therapy Registration Form
Please select with event/date you are registering for:
*
Adaptive Waterskiing @ Lake Lashaway, Saturday, June 7, 2025
Adaptive Surfing @ Horseneck Beach, Friday, June 20, 2025
Adaptive Waterskiing @ the Sand Bar Tyngsboro, Wednesday, August 20, 2025
Adaptive Surfing @ Horseneck Beach, Friday, September 5, 2025
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Participant Information:
Full Name
*
First Name
Last Name
DOB
*
-
Month
-
Day
Year
Date
What gender do you identify as?(Collected for grant purposes only)
*
Female
Male
Nonbinary
Transgender
Prefer Not to Say
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
All JTF communication for programming will be via email!
Level of Injury
*
Have you tried surfing post SCI?
*
Yes
No
Have you tried water skiing post SCI?
*
Yes
No
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Emergency Contact Information
In case of emergency, who should we contact?
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Relationship to Participant
*
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How did you hear about the Jack Trottier Foundation?
*
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All registered participants MUST fill our the insurance form
here
.
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