Fit & Fun for Adults Registration RegistrationPayment Method* Pay Online Pay by Check Organization Athletes Attend SABAH with*Athlete's Name* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone Number*Cell NumberEmail* Gender*MaleFemaleDate of Birth* MM slash DD slash YYYY Ethnicity (for funding purposes only)*African-American/BlackAsianCaucasian/WhiteHispanicNative AmericanOtherWeight (for grant funding purposes only)School / Group HomeIs the athlete over the age of 18?* Yes No Parent / Guardian / Caregiver #1Parent #1 will receive a confirmation e-mail for this registration.Parent / Guardian / Caregiver #1* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Employer*Employer Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Primary Email Address* Parent / Guardian / Caregiver #2Parent / Guardian / Caregiver #2 First Last Home Address (optional, if different) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code EmployerEmployer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberParent / Guardian / Caregiver 2 Email Address Emergency ContactName* First Last Phone Number*Athlete Diagnostic InfoPlease supply any and all information that applies to your athlete.How does your athlete communicate? Speech Sign Language Non-Verbal Other If other, please explain:Does your athlete wear AFO's?NoYesDoes your athlete have seizures?NoYesIf yes, how often do they occur?How long do they last?When did their most recent seizure occur?Does your athlete have a shunt?NoYesDoes your athlete have any of the following conditions? Autism/Spectrum Disorder Cerebral Palsy Hearing Impairment Learning Disability Down Syndrome Intellectual Disability Visual Impairment Other disabilities not listed above If yes, which of the following do they use: Hearing Aid Sign Language Read Lips Additional hearing impairment info:Additional learning disability info:Intellectual DisabilityDoes your athlete have any functional vision?Other disabilities not listed above:Does your athlete have any medical limitations or precautions?NoYesIf yes:Other InfoIs your athlete eligible for reduced-fee lunches?NoYesIs your athlete interested in our Adaptive Ice Hockey Program?YesNoIs wheelchair access needed?YesNoPermissionI hereby give my permission for my athlete to participate with SABAH in weekly therapeutic and recreational sessions as well as in SABAH’s Annual Celebration on Ice Show. The athlete may be photographed, videotaped or interviewed for the purpose of improving the quality of services provided by SABAH or for publicity purposes. It is the purpose of this agreement to exempt, waive and relieve releases from liability for personal injury, property damage, and wrongful death, including if caused by negligence, including the negligence, if any, of releases. “Releases” include SABAH Inc., event hosts, other participants, sponsors, advertisers, Board of Directors, volunteers and each, their officers, directors, agents and employees.Please check the box to accept:* I ACCEPT THESE TERMS Skater Registration Fee* Price: Would you like to receive news & updates from SABAH? Yes, I would like to be added to your mailing list. 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