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Adaptive Pickleball Social

Thank you for your interest in joining our Adaptive Pickleball Social! This event is a collaboration between the Lynn Rehabilitation Center and Strength and Faith Foundation.
Please complete the registration form as accurately as possible. Your response will help our team understand your experience, mobility needs, and any precautions or accommodations you may require. This information allows us to create groups with similar skill levels, provide appropriate support, and ensure a safe, enjoyable, and inclusive experience for everyone.
If you have any questions or require accommodations not addressed in this form, please don't hesitate to contact us. We look forward to seeing you on the court!

Section 1: Personal Information

Full Name

Phone Number

Email Address

Zip Code

Emergency Contact Name:

Relationship:

Emergency Contact Phone Number:

Section 2: Participant Background

What is your primary disability?

What is your primary disability?
A
B
C
D
E
F

If you have an SCI, what is your injury level?

If you have an SCI, what is your injury level?
A
B
C
D
E

Are you currently participating in outpatient therapy or a rehabilitation program?

Are you currently participating in outpatient therapy or a rehabilitation program?
A
B

Section 3: Mobility & Assistance Needs

What best describes your primary method of mobility?

What best describes your primary method of mobility?

What level of assistance do you typically require during recreational or sport activities?

What level of assistance do you typically require during recreational or sport activities?
A
B
C
D
E
F

Will you be attending with a caregive, family member, or support person?

Will you be attending with a caregive, family member, or support person?
A
B

Do you anticipate needing assistance with any of the following? (Check all that apply)

Do you anticipate needing assistance with any of the following? (Check all that apply)

Section 4: Health & Safety Considerations

Do you have any medical precautions or restrictions we should be aware of? (Check all that apply)

Do you have any medical precautions or restrictions we should be aware of? (Check all that apply)

Do you have any current injuries or health concerns that may affect participation?

Do you have any current injuries or health concerns that may affect participation?
A
B
C

Are you cleared by your physician or rehabilitation team to participate in recreational sport activities?

Are you cleared by your physician or rehabilitation team to participate in recreational sport activities?
A
B
C

Section 5: Pickleball Experience & Skill Level

How would you rate your pickleball skill level?

How would you rate your pickleball skill level?
A
B
C
D

What are your goals for participating? (Check all that apply)

What are your goals for participating? (Check all that apply)

How physically active are you currently?

How physically active are you currently?
A
B
C
D