MIDWEST ADAPTIVE SPORTS

Registration for our 4th Annual Tubing 101 and Winter Ski and Snowboard sessions are currently underway. Check out our calendar for details about each event!

Adaptive Winter Sports Registration


PARTICIPANT INFORMATION:

NAME:   PARENT / GUARDIAN NAME:   
AGE:  DATE OF BIRTH:   MALE    FEMALE 
ADDRESS:  
CITY:    STATE:    ZIP CODE:
DISABILITIES:
OTHER INFORMATION:



CONTACT INFORMATION:
 
CELL PHONE: WORK PHONE: HOME PHONE: 
EMAIL ADDRESS:  
 


REGISTRATION:





SIGN UP FOR ONE OR MORE OF THE FOLLOWING SERIES*

SELECT SERIES DAY DATES
  1) OPEN SESSION SATURDAY 1/7/2017
1/21/2017
1/28/2017
  2) OPEN SESSION SUNDAY 1/8/2017
1/22/2017
1/29/2017
  3) BLIND / VI AND OPEN TUESDAY 1/3/2017
1/10/2017
1/17/2017
1/24/2017
  4) SNOWBOARD AND OPEN WEDNESDAY 1/4/2017
1/11/2017
1/18/2017
1/25/2017
  5) MONO-SKI AND OPEN THURSDAY 1/5/2017
1/12/2017
1/19/2017
1/26/2017
  6) OPEN SATURDAY 2/4/2017
2/11/2017
2/25/2017
  7) OPEN SUNDAY 2/5/2017
2/12/2017
2/26/2017
  8) BLIND / VI AND OPEN TUESDAY 1/31/2017
2/7/2017
2/14/2017
2/21/2017
  9) SNOWBOARD AND OPEN WEDNESDAY 2/1/2017
2/8/2017
2/15/2017
2/22/2017
  10) MONO-SKI AND OPEN THURSDAY 2/2/2017
2/9/2017
2/16/2017
2/23/2017

  SINGLE VISIT – LIST 1ST, 2ND, 3RD CHOICE OF DATE & TIME*
 
*SUBJECT TO AVAILABILITY


PAYMENT TYPE

PLEASE SELECT A PAYMENT OPTION

CHECK CREDIT CARD 


TO COMPLETE REGISTRATION, CLICK SUBMIT FOR PAYMENT DETAILS

    

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