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Volunteer Profile Welcome new Volunteers Please fill out a volunteer profile to become a volunteer.
A complete profile helps with event planning and will speed up your event sign-up process.
Returning Volunteers Please check and update your profile every season.
An up-to-date profile helps with event planning and will speed up your event sign-up process.
Please contact info@adaptivesportsconnection.org or call 614-389-3921 for any questions.
Please fill in or answer all items with an *.
PERSONAL INFORMATION
First Name *
Last Name *
Street *
Street2
City *
State *
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
U.S. Minor Outlying Islands
Virgin Islands
Armed Forces Americas
Armed Forces Europe, the Middle East, an
Armed Forces Pacific
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut Territory
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Zip *
County *
Email *
Phone *
Birth Date *
/ / (mm/dd/yyyy)
Approx weight (lbs)
Approx height (ft, in)
I identify my gender as *
Female
Male
Non-Binary
Transgender
Cisgender
Prefer Not to Say
Prefer to Self-Describe
I identify my as race (select all that apply) *
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander
Prefer Not to Say
Not listed
I identify as being of Hispanic or Latino/a/x origin *
No, I am not Hispanic, Latino/a/x, or Spanish Origin
Yes, I am of Hispanic, Latino/a/x, or Spanish Origin
Do you consider yourself a member of the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and/or Asexual (LGBTQIA+) community? *
Yes
No
Prefer Not to Say
How did you find out about us?
EMERGENCY CONTACT Please provide a contact who will be available during the time you are at a Adaptive Sports Connection event.
Emergency Contact *
EM contact relationship
Emergency Phone *
PARENT/LEGAL GUARDIAN INFORMATION
Are you your own Guardian? *
YES
NO
Complete this section if the volunteer is a minor or legally incapacitated.
Guardian Name
Relationship
Guardian Street Address
Guardian City
Guardian State
Guardian Zip
Guardian Email
Best phone number to reach guardian
MILITARY ONLY
Military Service Y/N *
YES NO
If you have done Military Service, then please complete the next section.
VA Eligible
YES
NO
Branch of Service
Air Force
Army
Coast Guard
Marine Corps
National Guard
Navy
Other
Military Rank
Service Connected Disability
YES
NO
Served Post-911
YES
NO
Home VA Office
MEDICAL INFORMATION
Have you had surgery in the last six months? *
YES
NO
If YES, then please describe:
Currently taking medications? *
YES
NO
If YES, please list all, including over-the-counter medications:
Allergies? *
YES
NO
If YES, please list
Do you carry an EpiPen? *
YES
NO
INTERESTS AND SKILLS
Occupation
List other places you have volunteered, if any.
Do you have experience working with people with disabilities or adapted sports?
YES
NO
Please explain
List any certificates or special training /skills, if any. Please include expiration dates.
Volunteer Interests / Skills *
Administrative (office, data entry, clerical, etc.)
Alpine Skiing
Amputee Soccer
Amtryke
Boat Driver
Cycling
Climbing
Event Planning
Exhibits and Presentations
Fundraising
Kayaking
Leadership
Sailing
Stand Up Paddle Boarding
Trailer Driver
US Paralympics Team
Veterans Events
Water Sports/Wounder Warrior
Week Daytime Volunteers
Winter Sports Challenge
List any other volunteer skills
DISABILITY INFORMATION If you have a disability, please fill out this section. If no disability, then continue to the end of this form and select the Submit button.
Do you have a disability? *
YES
NO
Prefer Not to Say
Disability/Diagnosis (please do not use acronyms)
Date of injury or onset
Disability (select all that apply)
Able-bodied
Amputee - arm
Amputee - multiple
Amputee - above knee
Amputee - below knee
Amputee - leg
Aspergers
Autism
Cardiac/Heart condition
Cerebral Palsy
Diabetes
Down syndrome
Hearing Imparement - Total
Hearing Imparement - Partial
Multiple Sclerosis
Muscular Dystrophy
Post Traumatic Stress Disorder
Respiratory condition
Spina Bifida
Spinal Cord Injury
Stroke
Traumatic Brain Injury
Visual Impairment - Total
Visual Impairment - Partial
Other
Please explain any other disabilities
Assistive devices:
AFO/Leg braces
Ambulatory
Cane
Crutches
Manual wheelchair - part time
Manual wheelchair - full time
Power wheelchair - part time
Power wheelchair - full time
Prosthetics
Walker
Other
Assistive Devices - other
Medical details
Limited range of motion in any limbs
Difficulty with balance
Wear any sort of spinal stabilization
Any type of paralysis
Sensitivity to hot or cold
Difficulty speaking or communicating
Difficulty remembering or following directions
Emotional and/or behavioral concerns we should know about
Cognitive or developmental delay
Heart/cardiac condition
Respiratory condition
Other disability Info
FINAL COMMENTS
Please provide any additional information that will help us create a successful experience for you.
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