Advanced Recreation Therapy Registration Form
Please select with event/date you are registering for:
*
Boston Red Sox vs Cincinnati Reds, Fenway Park, Monday, June 30, 2025 @ 7:10 pm
Boston Red Sox vs Colorado Rockies, Fenway Park, Tuesday, July 8, 2025 @ 7:10 pm
Impossible Dream Sail, Newburyport, MA, Saturday, August 16, 2025 @ 10:00 am
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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.
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.
Relationship to Participant
*
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Participation in this experience includes 1 ticketed entry for participant with SCI, and 1 ticketed entry for a companion, per request. Please select from the following:
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Yes, I will need a companion ticket
No, I will not need a companion ticket
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I understand that by participating in this JTF experience, I am responsible for all transportation and parking at Fenway Park. Participation includes ticketed entry to ADA seating with 1 companion.
*
I understand
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How did you hear about the Jack Trottier Foundation?
*
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