2012 National ID Camp: Registration Form:

2012 US Rowing Development Camp for Persons with Intellectual Disability
Athlete Information Form
Name:_____________________________________________   Today’s date:___________________
Address:___________________________________________________________________________Zip:______________
Phone #:___________________________ E-Mail:___________________________________Birthdate:________________
Parent/Coach/ Name_________________________ Phone_________________________ Email:_____________________
In case of emergency, whom should we contact:___________________________________  Cell #____________________
Section I: General Questions

Describe your swimming ability:
Describe your rowing experience (please be specific):

 

 

Section 2: Medical Information and History
Have you ever had any of the following? (please chech the yes or no column)

Condition
Yes
No
Condition
Yes
No
Are you greatly affected by heat?
Allergies
Heart disease
Asthma
High Blood Pressure
Are you taking medication?
Do you get cold easily?
If yes, are there any side effects of the medication such as sun sensitivity, increased thirst, or fatigue?
Are you allergic to insect bites or bee stings

If yes, do you carry medication?
Seizures:
If yes what triggers them?
If yes, what is the date of you last seizure?
Back problems

 

 

Diabetes
Other?

 

***If you answered YES to any of the medical questions, please explain:

 

 

 

*So that we can better understand your needs, please list any medical, physical, psychological, or emotional issues not mentioned above: Please note type of learner – visual/ auditory, etc

 

 

 

 

 

What interests you about attending the Development Rowing Camp?

 

 

What do you hope to get out of Camp participation?      (Your Goals):

1.
2.
3.

Please attach with this form, your payment & the following documentation:
Evidence of fitness (submit current training + any competition results showing times and distances raced—any sport.
Evidence of being able to tread water for 5 minutes
Meet intellectual disability criteria  (www.athleteswithoutlimits.org) Please state IQ/ Diagnoses an Adaptive Score if available and age of onset

***Please return this Form; Documentation and Camp Fee: $200  to:
Please make checks payable to Texas Rowing For All & send to:

Diane Mc Diarmid
Texas Rowing For All
US Paralympic Sport Club
5715 Bexley Ct.
Austin, Texas 78739