Midwest Adaptive Sports
Tubing 101 Registration Form
January 23, 2025
Each person with a disability must complete a registration form (for MAS to continue receiving grant funding for this event).
Is this an individual (participant's friends and family) reservation or a group (school, group home, etc.) reservation?
Individual
Group
Group Reservation Name (The name for all members of your party to use when they arrive so that we can find the correct reservation.)
Name of Individual with a Disability
Email
Parent/Legal Guardian Name
Cell Phone Number
Home Phone Number
Work Phone Number
Date of Birth
MM
/
DD
/
YYYY
Age
Gender
Female
Male
Disabilities
Do you use a wheelchair or other ambulatory device for mobility on a daily basis?
Yes
No
Military Service
Active Duty
Veteran
Neither
Branch of Service
Army
Navy
Air Force
Marines
Coast Guard
Space Force
National Guard
None of the Above
Military Rank
Service related Injury
Yes
No
Does Not Apply
Place (AO) of Injury
Pre/Post 2001 Injury
Injured Pre 2001
Injured Post 2001
Does Not Apply
Will the individual with a disability be tubing or watching?
Tubing
Watching
How many friends or relatives without disabilities will you be bringing to TUBE with you?
(ONLY count the number of friends and relatives who will be TUBING and DO NOT count these people in another reservation if they are coming with more than one individual with a disability)
0
1
2
3
4
5
6
0
How many friends or relatives will you be bringing to WATCH the event?
(ONLY count the number of friends and relatives who will NOT be tubing and DO NOT count these people in another reservation if they are coming with more than one individual with a disability)
0
1
2
3
4
5
6
0
How many staff members will be TUBING?
(ONLY count the number of staff members who will be TUBING and DO NOT count these people in another reservation if they are coming with more than one individual with a disability)
How many staff members will NOT be tubing?
(ONLY count the number of staff members who will NOT be tubing and DO NOT count these people in another reservation if they are coming with more than one individual with a disability)
Other Pertinent or Helpful Information
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Midwest Adaptive Sports
Tubing 101 Registration Form
January 23, 2025
Reservations are subject to availability and MAS reserves the right to limit the number of participants based on how many tubing tickets are available. Preference will be given to those that have not participated yet this year.
E-mail midwestadaptivesports@gmail.com ASAP for any cancellations (so that we can accept people on the wait list). Thank you.
Register
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