Wheelchair Rugby Tournament Registration

Wheelchair Rugby Tournament

All players, coaches, support staff and team reps need to complete the tournament registration form and waivers. After submitting this form, you will be directed to a link to sign the liability and media waivers. Please contact us with any questions at 203-284-2772 or sports@gaylord.org. For more information on the tournament, please visit the event webpage at www.gaylord.org/wheelchairrugbytournament. For more information on our programs, please visit www.gaylord.org/sports.
General Information
I would like to register for:*

Battle of the Northeast Wheelchair Rugby Tournament - January 24-25 2026
Type of Registration:*

PlayerVolunteerCoachTeam RepresentativeOther
What team are you registering with?
Please select your current wheelchair rugby classification. If you are not a players, select "Not applicable"

0.51.01.52.02.53.03.5Not applicable/Not a wheelchair rugby player
T-Shirt size*
General Information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Date of Birth*

MonthDayYear
What is your gender?*

MaleFemaleI prefer not to answer
Are you a Veteran?*

YesNo
Please select your current military status:

VeteranActive Military DutyReserve
What is your service branch?
Please select your military service:
Do you have a military disability classification?

YesNo
If yes, what % disabled?
How would you best describe yourself?*

WhiteAsian (Origin: example Chinese; Indian; Afghan; Filipino; Iranian; etc.)Black/African AmericanAmerican Indian or Alaska NativeNative Hawaiian or other Pacific IslanderPrefer not to answerOther
Are you of Hispanic/Latino/Spanish origin?*

No, not of Hispanic, Latino, or Spanish originYes, I am of Hispanic, Latino, or Spanish (Origin: example Mexican, Puerto Rican, Cuban, Dominican, Colombian, Spaniard, Ecuadorian, etc.)
Please select:*

I am over the age of 18 and can legally sign for myself.I am either under the age of 18, legally conserved or not my own guardian.
Name of Legal Guardian or Conservator

First NameLast Name
Phone Number of Legal Guardian
Please enter a valid phone number.
Relationship to Participant
Emergency Contact *

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship of Emergency Contact *
Do you have any dietary restrictions? Please check all that apply.*

No restrictionsI am vegetarianI am gluten freeLactose IntolerantPeanut allergyTree Nut allergy
Please indicate any other dietary restrictions.
Medical Information
What is your primary diagnosis? (If none, choose "I do not have a disability" below).*

Spinal Cord InjuryMultiple SclerosisStrokeAcquired Brain InjuryAmputeePTSDSpina BifidaVisual ImpairmentCOPDTraumatic Brain InjuryI don't have a disabilityOther
Type of SCI

CompleteIncomplete
Level of spinal cord injury
Secondary Diagnosis (if applicable)
Date of initial onset of primary diagnosis
Please indicate if you have any of the below conditions?*

AllergiesAsthmaDiabetesCardiac ConditionHearing ImpairmentSeizures/History of seizuresDifficulty breathingHospitalization(s) within the past yearChronic PainMobility ImpairmentsCognitive Impairments (learning new things, following directions, memory)Difficulty with communication, making my needs known or people understanding meMental Health condition (readjustment issues, anxiety, depression)Behavioral or emotional difficulties (impulsive, easily frustrated)I have none of the above conditionsOther
If any of the above apply, please provide additional information here. Or, please make any additional comments about your disability or medical history that we should be aware of:
Do you use an assistive mobility device?*

Manual WheelchairPower WheelchairWalkerCaneNone
Will you be using a wheelchair while participating in a Sports Association program?

YesNo
Do you have any questions or additional information you would like to share?
Acknowledgment
By submitting this form, I verify that the above information is current and accurate. I understand that the above information will be kept confidential. In order to provide a safe and fun experience your information may be shared with: (1) Sports Association staff, coaches or instructors (2) other adaptive sports programs who will be working with you (3) medical professionals in case of emergency (4) as required for Sports Association grant reports. I understand that it is my responsibility to inform the Sports Association regarding changes to my: (1) contact information such as address, phone and email; (2) medical status including new diagnosis, surgery or medical changes; (3) any other information that is relevant to the safety of myself or others regarding my participation in Sports Association programs.
Today's Date*

MonthDayYear
Date
Name of person completing form:*

First NameLast Name
If not self, please indicate relationship to participant (friend, guardian, therapist, etc.)
Signature*

Clear
Liability & Media Waiver
All attendees including participants, volunteers, and coaches must sign an annual liability waiver and optional media release. Once this form is submitted, please follow the instructions provided to sign the online waiver.
Should be Empty:

Wheelchair Rugby Tournament

General Information

General Information

Medical Information

Acknowledgment

Liability & Media Waiver