Dreamplex Para Sports Track & Field - Registration

"*" indicates required fields

Max. file size: 50 MB.
Max. file size: 50 MB.

Participant Information

Please enter the following information about the person participating in the program.
Name*
Date of Birth*
Disabilities*
What is the primary disability associated with the participant? (if applicable)
(Optional) Please feel free to expand on the participant's disabilities, or any other information about the participant, here. Include anything you would like the instructors/coaches to know.
Does the participant have their own equipment they'd like to use?

Participant Contact Information

Please enter the contact information for yourself, the parent, or caregiver
Name*
(e.g. Self, Parent, Caregiver)
Address*

Emergency Contact Information

Please enter the contact information in case of emergency. (someone who will NOT be in attendance at the event and NOT the same person listed above)
Name*
This person will be contacted, only in the case of emergency