Athlete Profile Mt. Brighton Adaptive Sports

*NEW ATHLETES: Please complete the profile form below to create a profile in our database.*

*RETURNING ATHLETES: Please complete this form once a year so that your information stays up to date*

Completing this form helps us maintain the most up to date contact information as well as ensure we have the most up to date information regarding your needs and health information so that you have an enjoyable experience at our adaptive downhill snow sport events

Athlete Contact Information

First Name *

Last Name *

Email *

Gender

Date of Birth *

Address Line 1 *

Address Line 2

Phone *

City *

State *

State/Province

Zip *

Postal Code

Country / Region

Emergency Contact *

Emergency Contact Phone *

Emergency Contact Email

Athlete Demographics

What is your preferred name? The maximum length for the field What is your preferred name? is 500 characters.

What are your preferred pronouns?

I identify my race as (select all that apply): * The field I identify my race as (select all that apply): is required.

Are you of Hispanic or Latino Origin? * The field Are you of Hispanic or Latino Origin? is required.

Are you a veteran? * The field Are you a veteran? is required.

(Are you a veteran?) If Y Which branch? The maximum length for the field (Are you a veteran?) If Y Which branch? is 500 characters.

Are you a minor or have a legal guardian? * The field Are you a minor or have a legal guardian? is required.

(Are you a minor?) If Y please provide your parent/legal guardian's name and phone number The maximum length for the field (Are you a minor?) If Y please provide your parent/legal guardian's name and phone number is 500 characters.

General Physical Information

Approx height * The field Approx height is required.

Approx weight * The field Approx weight is required.

Shoe Size (if you require ski/snowboard rental) The maximum length for the field Shoe Size (if you require ski/snowboard rental) is 500 characters.

Allergies * The field Allergies is required.

List allergies The maximum length for the field List allergies is 500 characters.

Do you Have an Epi-Pen * The field Do you Have an Epi-Pen is required.

Currently Taking Meds? * The field Currently Taking Meds? is required.

(Currently taking meds?) if Y = list them The maximum length for the field (Currently taking meds?) if Y = list them is 5000 characters.

Do You Have a History Of Seizures? * The field Do You Have a History Of Seizures? is required.

Date of Last Seizure The maximum length for the field Date of Last Seizure is 500 characters.

Disability Information

Please fill out this section as accurate and detailed as possible to ensure we can provide you with a safe and enjoyable adaptaive downhill snow sport experience.

Do you have a disability? * The field Do you have a disability? is required.

(Do you have a disability?) if Y select applicable * The field (Do you have a disability?) if Y select applicable is required.

Disability - Other Please Explain * The field Disability - Other Please Explain is required.

List all Medical diagnoses (do not use acronyms) * The field List all Medical diagnoses (do not use acronyms) is required.

Please select all that apply related to your disability/disabilities * The field Please select all that apply related to your disability/disabilities is required.

(Please select all that apply related to your disability/disabilities) For any box(es) checked please provide details here: * The field (Please select all that apply related to your disability/disabilities) For any box(es) checked please provide details here: is required.

Do you use any assistive devices? * The field Do you use any assistive devices? is required.

(Do you use any assistive devices?) If Y select all that apply * The field (Do you use any assistive devices?) If Y select all that apply is required.

Assistive Devices Used - Other (please explain) * The field Assistive Devices Used - Other (please explain) is required.

Can You Walk? * The field Can You Walk? is required.

(Can you walk?) if Y how far? * The field (Can you walk?) if Y how far? is required.

Are you able to climb a flight of stairs? * The field Are you able to climb a flight of stairs? is required.

If wheelchair, independent transfers? * The field If wheelchair, independent transfers? is required.