Adaptive Sailing participant form

Adaptive Sailing Participant Information

Please fill out the participant information form, so we can better meet your needs.

Name

First Name

Last Name

Email

Phone number

(###)

###

####

Student's date of birth

MM

DD

YYYY

Name of Parent/Guardian (if applicable)

Phone number

(###)

###

####

Email

Emergency contact (name and relationship to participant)

Phone number

(###)

###

####

This information is to provide you the best service possible.

Disability type:

Physical

Cognitive

Developmental

Other

Please describe your disability:

Any adaptive equipment used on land?

(Wheelchair, walker, etc.)

Do you require assistance for transfer into the boat?

(Hoyer lift, transfer bench)

Have you had any seizures in the last 2 years?

Yes

No

Do you have any allergies?

Do you have a service animal?

*We don’t allow service animals on the boats and cannot care for them on land.