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Registration Form

Before you visit the Adaptive Sports Center, this form must be filled out in its entirety. After submission, we will contact you shortly to confirm the reservation and collect a deposit. Please call with any questions (970) 349-2296 or email us at info@adaptivesports.org. You must sign our waivers when you arrive at the ASC.


Please note: Due to the safety of our participants, instructors and equipment limitations, we have a strict 200lbs. weight limit for our sit ski program.


We look forward to seeing you soon!

Preliminary Information

       
Date      Group Name
(if applicable)
Name of student   Name of guardian
    Relationship
Address
City
State
 Zip 		  Home phone
Cell phone
Date of birth   Sex
Height
**Weight

Email/Fax (for confirmation)   Emergency contact
Phone 
Disability (please be specific)

If the disability was caused by an accident,
please give date of accident:
*Any allergies?   If yes, to what
Subject to seizure?   If yes, date of last seizure?
Any surgeries in the past year? If so please explain when and what surgery.
* Currently taking any medication(s)? Yes  No   If yes, what medication(s)
*Are any of the meds for: seizure? blood thinning? diabetes?
Please describe any specific areas of relative physical weakness
       

Physical and Social Information

     
Please describe primary means of locomotion

Does the participant use a wheelchair? Yes No   Manual Electric

Please describe the strength and use of lower extremities

On a scale of 1-5 please rate participant’s upper body strength: poor12345 excellent

On a scale of 1-5 please rate participant’s balance: poor12345 excellent

What other sports or activities does the participant participate in?

What are the participant’s goals for the visit?
       
If you are a parent registering your child in our program or if you feel that this information is pertinent:
Please describe your child/participant’s social interactions with his/her peers:
Please describe your child/participant’s interactions with adults:
Are there any issues you feel we should be aware of?
 
Do you have any additional comments or suggestions?
       

Scheduling Details

     

Date of arrival in Crested Butte?

  Date of departure?
Including yourself, how many people are in your party?
How many days of activity are you interested in?
Which of the following activities (1= first choice) is the participant interested in?
Winter Activities:
Skiing
Snowboarding
Nordic Skiing
Snowshoeing
Hut Trip
Summer Activities:
Challenge Course Handcycling
Canoeing Kayaking
Whitewater Rafting Hiking
Rock Climbing Camping
Downhill Biking    

What past experience does the participant have in the above activities?
Does the participant have any activity equipment currently? Yes No
What adaptive equipment was used in the past?
Where will your party be staying in CB?
(Please check one to the right)
Phone
Club Med
Crested Butte International Hostel
Crested Butte Properties
The Grand Lodge
Personal Residence
Other

Was the fact that the Adaptive Sports Center is in Crested Butte an important factor in the decision to vacation here? Yes No

Would you have come to Crested Butte if an adaptive recreation program was not available?
Yes No
How did you hear about the Adaptive Sports Center? Ad  What Publication? Internet
Chamber of Commerce Local Resident
CBMR Literature Travel Agent
Crested Butte Ski School Word of Mouth
Former Student Other
What were your main influences for choosing the ASC?

Crested Butte  | About Us  | Our Team  | Sponsors  | Join Our Team
P.O. Box 1639 Crested Butte, CO 81224 | Toll free (866) 349-2296 | info@adaptivesports.org
Program Office (970) 349-2296, fax (970) 349-2077 | Administration office (970) 349-5075, fax (970) 349-2077