Summit Adaptive Sports Participant Form

Welcome to Summit Adaptive Sports!

Summit Adaptive Sports is please to offer programing for Veterans and Members of the Armed Services who have a permanent disability as part of the Move United VA Adaptive Sports Grant Program for 2023 - 2024.

Participating in sports provides lifelong opportunities for physical and mental development as well as opportunities for individual accomplishment and inclusive family activities. Summit Adaptive Sports provides access and instruction in outdoor sports to individuals with developmental or acquired disabilities.

For more information on our organization, programs, and frequently asked questions please visit our website at summitadaptive.org. If you still have questions or need assistance completing this form please email us at summitadaptivesports@gmail.com or call Summit's office at Ski Sundown 860-379-7669 ext 221.

Steps to Register:

Step 1: Complete this questionnaire so that we can learn more about you (or your family member) and interests so that we may best plan your lesson(s) experience.

Step 2: At the end of the questionnaire you will receive a confirmation thank you page with links to our waivers to be signed electronically.

Step 3: A member of the Summit Adaptive Sports team will contact you to schedule your lessons.

Medical Information
Primary Diagnosis*
Secondary Diagnosis if applicable
If you have an acquired disability please tell us the date and location the injury occurred. Type in 'NA' if not applicable. *
Please provide any additional information that may be helpful.
Do you have allergies?:*

YesNo
Please describe the allergies:*
(For example: severe nut allergy, seasonal, pollen, medication etc..)
Do you carry an Epi Pen, and where is it located when you are participating in sports? *
(If you do not carry an Epi Pen, please write N/A or No in this section.)
Do you have seizures currently or is there a history of seizures?*

YesNo
Please describe type and frequency of seizures.*
Upload Physician Seizure form if available. If not available, please send to us at summitadaptivesports@gmail.com at least two weeks prior to your first scheduled activity.

Cancelof
Please list any medications currently taking that could have an effect on the lesson:
(For example: make drowsy, frequent bathroom needs, sensitive to sun, etc..)

Communication and Learning Style
Describe your most successful learning style (please choose one):

VisualAuditoryKinesthetic
Please share any additional information about communication needs or preferences that will help us prepare for the lesson?
(For example: 'use 5 words or less when giving directions', or 'doesn't understand 'pizza' as ski wedge term, better to use triangle or letter V' )