Adaptive Sports NW · Adaptive Sports Northwest Membership Registration

Personal Information

Tell us a bit about yourself.

Participant Name *

First Name

Last Name

Mailing Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Primary Phone *

Alternate Phone

E-mail Address *

Verify Email *

Alternate E-mail Address

Verify Email

Contact preferences *

Prefer phone calls

Prefer texts

Prefer emails

Do not call

Do not email

No fundraising contacts

Current role within ASNW

i.e. Head Coach - Goalball; Board Member; etc.

Parent/Guardian *

First Name

Last Name

Parent/Guardian

First Name

Last Name

Emergency Contact Info

We need this before you take the field.

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

Emergency Contact Relationship to Member *

Sensitive Information

We realize this information is personal. We need it to provide the best possible service and to ensure funding keeps our programs active.

Date of Birth *

(mm/dd/yyyy)

Gender *

Please select your preferred pronouns

Do you identify as part of the LGBTQ2IA+ community? *

Race or Ethnicity *

Asian/Asian-American

Black/African American

Eastern European/Russian

Latino/a/x or Hispanic

Multiracial

Native American/Indigenous/Alaska Native

Native Hawaiian/Polynesian/ Pacific Islander

White/Caucasian

Prefer not to answer

Veteran status *

Have you served/are you currently serving in the US Armed Forces?

Yes

No

Do you have a disability? *

Yes

No

Prefer not to answer

Disability *

What do you consider your primary disability? U.S. Paralympic Designated Classifications

Ambulatory *

Are you ambulatory?

Yes

No

Are you a current or former Paralympic and/or Team USA team member? *

Yes

No

National Team Highlights

Please share if you are willing. Example: Wheelchair Basketball Paralympic Team Member, Rio 2016, Gold Medal

Please add any Sensitive Info descriptions or notes here.

General Waiver of Liability

To be completed by all members.

The link below will open a new tab with our General Waiver and Release of Liability Form in a PDF format for your review. Please read it in its entirety before continuing on with our Membership form.

ASNW General Waiver and Release of Liability Form (PDF)

You may also contact our Staff to request a paper copy at any time.

General Waiver & Release of Liability *

By checking this box, I am acknowledging that I have read the General Waiter and Release of Liability for ASNW participants and fully understand the terms and contents.

By filling in my name below, I accept the conditions and terms of the ASNW General Waiver & Release of Liability *

First Name

Last Name

FOR PARENTS/GUARDIANS OF MINORS: By filling in my name below, I accept the conditions and terms of the ASNW General Waiver & Release of Liability *

First Name

Last Name

Expectations & Code of Conduct

To be completed by all athletes.

The link below will open a new tab with our Athletes Code of Conduct form in a PDF format for your review. Please read it in its entirety before continuing on with our Membership form.

ASNW Athletes Code of Conduct Form (PDF)

You may also contact our Staff to request a paper copy at any time.

Expectations & Code of Conduct *

By checking this box, I am acknowledging that I have read the ASNW Athletes Code of Conduct and fully understand the terms and contents.

By filling in my name below, I accept the conditions and terms of the ASNW Athlete Code of Conduct *

First Name

Last Name

FOR PARENTS/GUARDIANS OF MINORS: By filling in my name below, I accept the conditions and terms of the ASNW Athlete Code of Conduct *

First Name

Last Name

Payment Options

Membership Registration or Renewal Type *

Adult Athlete

Youth Athlete (under 18 years old)

Other

Membership Cost *

$100 - Adult Athletes

$75 - Youth Athletes

$50

$25

$

Additional Payment for Membership *

If you cannot make the full payment for your membership level at this time, please indicate how you would like to make up the difference. A member of our team will be in touch to discuss options and next steps.

I paid the membership fee in full.

I would like to apply for a scholarship or grant.

I am willing and able to complete volunteer service hours. Volunteer service is valued at $15/hour.

Additional Comments

If you have any additional comments to make, such as expanding on any of your previous answers, please do so here.

Whoo-hoo you made it to the end of the ASNW Membership Form!! Thank you taking the time to fill out this very important form; we appreciate you greatly.

The Submit button below will take you to the Payment Processing page where you can complete your Registration.

We can't wait to see you at the next event. Feel free to contact us at info@adaptivesportsnw.org if you have any questions.

Thank you!