ASRA athlete registration

ASRA Event and Sport Registration
Submission Date

- Month - Day Year
Registrant's Information
Participant Registration *

Youth Adult
Participant Type *

Able- bodied Physically Disabled
Full Name *

First Name Middle Name Last Name
Gender *

Male Female
Birthdate *

- Month - Day Year
E-mail *

Confirmation Email
Phone Number *

- Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Languages Spoken *

English Spanish Sign Language
Do you want to receive our newsletter and ocassional announcements? *

Yes No
Emergency Contact Name *

First Name Last Name
Emergency Contact Phone Number *

- Area Code Phone Number
Disability Type - Check all that apply *

Neuromuscular Orthopedic Hearing Impaired Vision Impaired
Neuromuscular Disability - Check all that apply *

Cerebral Palsy Multiple Sclerosis Nerve Damage Post Polio Spina Bifida Spinal Cord Injury and Paralysis Stroke Traumatic Brain Injury
Orthopedic Disability - Check all that apply *

Amputation Burns Dwarfism Fixation
Parent's Information
Parent Name *

First Name Last Name
Do the parent and registrant have the same information? Check all that are the same.

Address Phone Number Email

Parent Phone Number *

- Area Code Phone Number
Parent E-mail *
Demographic and Financial Information
Demographic Information: Please provide the following information. This information is used for grants and funding opportunities. It is not shared or used for any other reason. Your help is greatly appreciated.
Ethnicity (please check one) *

hispanic/latino african american native american/american indian asian/pacific islander white other
Are you a foster child? *

Yes No
Are you an veteran or service member? *

Yes No
When were you injured?

Injured Pre-2001 Injured Post-2001
Branch

U.S. Marine Corps U.S. Navy U.S. Army U.S. Air Force U.S. Coast Guard National Guard
Rank
Do you participate in any of the following financial assistance programs? *

no free school lunch program temporary assistance for needy families aid for dependent children foster care medi-cal/medicaid unemployment benefits
Event and Sport Selection
What sports do you want to register for?

Kayaking Sitting Volleyball (Ages 14 and older) Sled Hockey Wheelchair Basketball REGISTRATION NOT OPEN - Wheelchair Soccer (12 and under) Track and Field (ages 5 to adult)
Kayaking
What kayaking events would you like to register for? Select all that apply. *

April 16, 2016 - 9am-12pm; Shelter Island May 29, 2016 - 1pm-4pm; Lake Murray June 18, 2016 - 9pm-12pm; Lake Murray
The cost for kayaking is $30 total for athlete and additional paddler for each event.
Kayaking Total
kayak 1 total
kayak 2 total
kayak 3 total
Sled Hockey
Winter Season Information

The San Diego Ducks Sled Hockey Winter Season is September 3, 2016 to April 29, 2017. The season registration fee is $650 with a $50 discount for an early registration (by September 17), single and monthly practice payments, and more. This fee includes:
- Weekly practices on Saturday mornings, on the ice 7:15am-8:15am @ Poway Ice
- A minimum of 4 and up to 8 local scrimmages/games
- Expert coaching, equipment, and volunteer staff
- A free jersey (full season registration)
- Free equipment use and loaning
USA Hockey Registration

All players must be registered with USA Hockey prior to their first ice event. USA Hockey Registration opens April 1 and is valid from April 1, 2016 to August 31, 2017. First time sled hockey players may submit the paper Registration Form at their first ice event to receive a free USA Hockey registration. All returning players must have a current USA Hockey registration before signing up below. Please visit https://www.usahockeyregistration.com to register online or obtain your current USA Hockey Registration confirmation number.
Is this your first year playing sled hockey? *

Yes No
Please enter your USA Hockey confirmation number *
Team Selection *
Player Position *
T-Shirt Size *
Hockey Jersey Size *
Hockey Jersey Sizing Chart
Jersey Number Preference?
1-98
Second Jersey Number Preference? *
1-98
Sled Hockey Registration Type *
Do you require a payment plan?

Yes No
Payment Plan Option
Sled Hockey Total
Wheelchair Basketball
Division Selection *
Wheelchair Basketball Payment Option
Opting for the monthly payment plan is your selection to pay for the entire season in equal monthly payments due the first of each month for the entire season starting October 1 and ending April 1. The full division payment must be made by April 1. You are responsible for making the monthly payments on time. If you do not understand and agree to this policy then please select another payment option.
Wheelchair Basketball Total
Wheelchair Soccer
Select your preferred team location(s). Check all that apply. *

San Diego North County
Wheelchair Soccer is for athletes ages 12 and younger. The registration payment is $75 for the season.
Wheelchair Soccer Total
Track and Field
Track and Field is for any both ambulatory and wheelchair athletes ages 5 to adult. Practices are Sunday afternoons at Clairemont High School from 1pm-3pm. The registration payment is $75 for the season of April - June.
Track and Field Total
Please download, print, sign, and bring the following forms to your first event to participate in your selected activities. Please contact us for assistance.
Athlete Medical Form 2014 - please print, complete if 18 or older or take to your physician to complete if 17 or younger, and bring to your first ASRA meeting or event annually
2015 Disabled Sports USA - ASRA Liability Waiver & Media Release - please print, sign, and bring to your first ASRA meeting or event annually
USA Hockey Waiver/Registration - please print, sign, and bring to your first ASRA meeting or event for your first year - subsequent years require online registration
Payment
Total Registration Amount Due
Registration Payment Total

USD Registration
How would you like to pay? *
Do you wish to apply for financial assistance?

no yes
Please list any questions, comments, or requests.
Enter the message as it's shown *
By clicking on "Submit Registration" you agree to pay the Registration Payment Total by PayPal, credit, debit, cash, or check within 7 days of form submission, or request an ASRA scholarship by contacting us. Failure to do one or the other will forfeit the participant's ability to participate in the selected sport(s). Please email Thomas O'Connor at toconnor@asrasd.org or call 619-336-1806 with any questions.
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ASRA Event and Sport Registration

Registrant's Information

Parent's Information

Demographic and Financial Information

Event and Sport Selection

Kayaking

Sled Hockey

Wheelchair Basketball

Wheelchair Soccer

Track and Field

Please download, print, sign, and bring the following forms to your first event to participate in your selected activities. Please contact us for assistance.

Payment