2026 TRAS Snow Ski Program Participant Information Form

2026 TRAS Snow Ski Program Participant Information Form

Complete once for the 2026 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.Format: (000) 000-0000.
Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
List EMERGENCY CONTACTS including name, phone number and relationship.*
Date of Birth*
Age*
Primary Disability & Date of Onset*
Height & Weight*
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.
YesNo
If yes, please provide details.
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?*
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: *
YesNo
- Skiers w/ Spinal Cord Injuries less than one year since injury are required to provide a written physician clearance letter prior to skiing with the Three Rivers Adaptive Sports ski program
- Please note Level of SCI Injury
- YesNo
- If Yes, type of stabilization, location, and rod length.
- Do you have problems with skin integrity? Do you currently have any skin breakdown / wound area. If so, what is the location?
- Do you have decreased sensation / ability to feel Pain, Cold, or Pressure? Please provide details and body location.
- YesNo
- SkiedSnowboarded
- BeforeAfter
- BeginnerIntermediateAdvanced
- YesNo
- Provide details regarding past snowsport experiences.
- YesNo
- Please describe your previous adaptive ski experience(s)
- MONO SKI. Model used if known, tethered?
- BI SKI. Model used if known, hand held outriggers, fixed outriggers, tethered?
- TWO TRACK SKI. Include with or without poles, shoe / boot size, ski length if known, and any adaptive equipment.
- FOUR TRACK. Two skis with hand held outriggers, other devices if known such as ski tip stabilizer, spreader bar, tether, etc, shoe/boot size, length of ski.
- 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*
- Parent/Guardian Name if Participant is a MINOR.
- Parent/Guardian Signature
- 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
- Should be Empty: