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
Impossible Dream Catamaran Sail @ Newburyport, MA, Saturday, August 15, 2026
Performance Driving @ Lime Rock, CT, Saturday, October 3, 2026
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Participant Information:
Name
*
First Name
Last Name
DOB
*
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Month
-
Day
Year
Date
What gender do you identify as?(Collected for grant purposes only)
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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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Due to limited availability for the Impossible Dream Sail, we hope to provide as many individuals with SCI the opportunity to participate as possible. Out of respect for fellow participants, we ask that companions attend only if needed for support or assistance. Will you require a companion spot for this experience?
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Yes
No
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I understand that preference for the Impossible Dream Sail registration will be given to first-time participants until July 15 to help expand participation opportunities within the SCI community. Previous participants are asked to wait until after July 15 to register, based on remaining availability. Please note that all registration fees are nonrefundable upon submission of this form and payment completion.
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For Performance Driving, I plan to be a ...
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Driver
Passenger
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
$
25.00
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Please be aware that registration fees are nonrefundable.
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