“Every Day is Armed Services Day”
Registration

Please note: Student participation in Wintergreen Adaptive Sports is subject to review and evaluation by the WAS staff. The information contained on applications may be used internally by WAS staff and your volunteer instructors.

Have you taken a lesson with WAS before?

Name

First Name

Last Name

Contact Email Address

This will be the primary way WAS contacts the student.

Street or PO Box of student

What the Postal Service uses for mail

Town or City

State

Two letters, (VA for Virginia, for example)

ZIP code

Contact Phone #

(###)

###

####

Service Branch

Rank

Birth Date

YYYY

Disability Diagnosis or Injury

Place in which injury occurred/disability sustained

Date or Year of Diagnosis or Injury

YYYY

Height

List in feet and inches

Weight

List in pounds

Shoe Size

Emergency Contact

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Other Pertinent Information

Where applicable, (i.e., medical equipment or prosthesis, bowel and bladder management, seizures, hearing impairment, visual impairment, sensory loss, other):

Ski or Snowboard?

Adaptive Equipment Experience

Day(s) of Week You Are Interested in Taking a Snow Sports Lesson

All lessons are by appointment only and will be confirmed by phone

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Specific Dates on Which You Are interested in Taking a Snow Sports Lesson

List all prospective dates

Additional Comments

Please share any additional information that may assist our instructors in planning for your lesson (i.e. overall health, level of independence, etc.)

“Every Day is Armed Services Day”Registration

Map to our location at Wintergreen Resort

“Every Day is Armed Services Day”
Registration