Adaptive Rock Climbing Clinic

Hanger Clinic is inviting people with limb loss or orthotic bracing or any person living with a disability, to an adaptive rock climbing clinic. Supportive family and friends are welcome.

Date/Time: February 5, 2023 | 1:00-4:30 p.m.

Light snacks will be provided.

Event Cost: Free to all

Location: REACH Climbing & Fitness | 401 E 4th Street, Bridgeport, PA 19405

Questions? Please email Matt Johnson at maJohnson@Hanger.com

Registration Type *

Adaptive Athlete Attendee

Event Volunteer

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Gender/Age Group *

How did you hear about the Adaptive Sports Day? *

Are you a person with an orthotic device? *

Yes

No

What orthotic device(s) do you use? *

Are you a person with lower limb loss? *

Yes

No

Are you a person with upper limb loss? *

Yes

No

Are you a person with any other disability? *

Yes

No

What other impairment do you live with? *

Please rate your mobility level from 1 to 5 stars: *

1-star: Limited mobility; 5-star: Extremely active

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Are you a Hanger Clinic patient? * 🛈

Yes

No

Do you have prior experience rock climbing? Have you played other adaptive sports? *

Are you bringing a guest? *

Yes

No

Guest Information:

	First Name	Last Name	City, State	Email	Relationship to attendee
Guest #1	First Name	Last Name	City, State	Email	Relationship to attendee
Guest #2	First Name	Last Name	City, State	Email	Relationship to attendee
Guest #3	First Name	Last Name	City, State	Email	Relationship to attendee
Guest #4	First Name	Last Name	City, State	Email	Relationship to attendee

(Optional) Please share any information about your mobility/activity/personal goals that you have for this event.

Additional Requests, Dietary Needs, Comments, or Questions: