Clone of Utah Echo Blind Hockey 2026 Interest Form

Utah ECHO Blind Hockey Interest Form

Complete one form per individual.
Complete this form for each individual who would like to be involved with Utah ECHO Blind Hockey. Your information will not be used for other purposes.

Join the grassroots movement for Utah ECHO Blind Hockey & Learn to Skate

The Salt Lake 2034 Olympics & Paralympics is where Blind Hockey is anticipated to become an official Paralympic Sport. Let's make sure that happens by growing the sport.

We welcome both members of our hockey community and blind/VI community to sign up.

Please be specific regarding needed accommodations.
First Name*
Last Name*
Phone Number*
Please enter a valid phone number.
Age*
Gender*

MaleFemaleDecline to answerOther
City*
Zip Code*
Email Address*
Communication preference for Utah Echo Blind Hockey notifications:*

EmailGroupMe (text group)Other
How would you like to be involved with Utah Echo Blind Hockey during 2026-2027?*

Learn to skateLearn to playI want to play for Team USA!Volunteer- in person support on the iceVolunteer- in person support off the iceCommunity PartnerOutreach and FundraisingFanCoachOther
Skating or hockey experience?*

Never skated or rollerbladed in my lifeLearned to ice skateLearned to rollerbladeIce skated a few timesRollerbladed a few timesLearned to play hockeyPlayed competitive hockeyCoached Hockey
Do you need one to one support on the ice?*

Yes, please provide a support person for meYes, and my support person will accompany meNo, but I can provide support on the ice.
How familiar are you with blindness/visual impairment?

Not familiarSomewhat familiarVery familiar
Do you have other accommodation requests?*
Would you like more information regarding Learn to Skate or Learn to Play programs in your area?

Yes- Learn to SkateYes- Learn to PlayNot applicable
Visual Classifications*

B1 (nlp or lp only)B2 (up to 20/600 or a visual field of less than 5 degrees in the better eye with correction)B3 (20/600 to 20/200)B4 (low vision)None of these
Volunteers and Community Partners: If you are able to provide specific contributions or in-kind donations, please list them below and we will be in touch. Thank you!
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Utah ECHO Blind Hockey Interest Form