Advanced Recreation Therapy Registration Form
Please select with event/date you are registering for:
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Performance Driving @ Lime Rock, CT, Saturday, June 20, 2026
Performance Driving @ Lime Rock, CT, Saturday, October 3, 2026
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Participant Information:
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
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Level of injury
*
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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.
Format: (000) 000-0000.
Relationship to Participant
*
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For Performance Driving, I plan to be a ...
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Driver
Passanger
If you are planning on driving, please confirm the following:
I have a valid driver's license
I have been driving with hand controls for at least 2 years
I am able to transfer into a sedan without use of a slide board
I have full triceps function
I am taller than 5' 4" and have a seat width no greater than 20"
I am aware that driving is taxing. If traveling from a greater distance (>1 hour) it is recommended that driver's be a passenger to the track, or stay in a nearby hotel the night before the event. All drivers must arrive at the track at 9 am (1 hour prior to start).
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How did you hear about this event?
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Registration Fee
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Registration
$
25.00
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Please be aware that registration fees are nonrefundable.
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