ATHLETE UPDATE first name * last name * image age * Select 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23+ Date of Birth * School: * Select Shirt Size: * Select Size Youth Small Youth Medium Youth Large Youth X-Large Adult Small Adult Medium Adult Large Adult X-Large USA Field Hockey Membership Number (Optional) USA Lacrosse Membership Number (Optional) street * city * state * zip * diagnosis, if any * Emergency contact number * Medical Conditions/Allergies, If Applicable * Additional Caregiver Information First Name * Last Name * Phone * Email Please describe your child's previous experience with organized sports, if any. * My child is sensitive/fearful of: * What motivates your child? * What do we need to know to keep your child the safest? * Additional Questions/Comments * what is your child’s primary means of mobility * Ambulatory/No Mobility Device Used Assistive Device (Other Than Wheelchair) Power Chair User Manual Chair User classroom type * 8:1:2 inclusion general education services child receives (Please select all that apply) * physical occupational speech visual behavioral communication mode * verbally gestures sign language AAC device Child's Energy Level * high medium low child's attention * easily distracted needs input to motivate focused gender * male female Non-Binary Prefer Not to Say ethnicity Asian Latin-American Pacific Islander Native American White Mixed South Asian Prefer Not to Answer Sports you are interested in * Lacrosse Field Hockey Flag Football Volleyball Basketball Wheelchair Sports I have read and accept the Privacy Policy * Update
