Adaptive Sports Day Registration

Hanger Clinic is inviting people with limb loss or orthotic bracing needs to join us for an adaptive field day. Please join us for a day of peer support and activities, including wheelchair basketball, adaptive yoga, golf, seated volleyball, tennis, mobility exercises, and more. Supportive family and friends are welcome.

Date/Time: June 25, 2022, 8:30 AM-3:00 PM

Lunch will be provided.

Location: Salus University

8360 Old York Rd, Elkins Park, PA 19027

Registration and adaptive sports held at Hafter Student Community Center on Breyer Drive at Salus University; free parking on campus and at the community center.

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

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

Are you interested in participating in wheelchair basketball? * 🛈

Yes

No

Height (of person with limb loss) *

Weight (of person with limb loss) *

What adaptive sports have you play previously? *

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: