*Pre Registration is required. Without pre-registration, a t-shirt, goodie bag, and medal are not guaranteed.

Athlete information

First name: / Last: / Date:
Medical Diagnosis: / Age: / T-Shirt Size (circle/highlight one):
S M L XL YS YM YL
Address: / City/ State: / Zip code: / Height:
Athlete’s primary means of mobility is: / __ s/he walks by themselves
__ s/he walks with a handhold
__ s/he uses a walker, cane or crutches
__ s/he uses a manual wheelchair and pushes him/herself
__ s/he uses a power wheelchair and moves him/herself
__ requires an adult to carry him/her or push him/her in a stroller or wheelchair
100 M Run/Walk/Roll Event / This event will run throughout the day. After arrival, volunteers will help register the athletes for an appropriate race based on equipment and assistance required
Bike Riding and Races
(please check or highlight all that apply): / ___ I have my own bike and helmet and will bring them
___ I can ride a bike but need to borrow one from Outdoors for
All*
___ I have never ridden a bike/tricycle/adapted bicycle before, but would like to participate**
___ I have interest in using/trying the following type(s) of bikes:
oTandem or side by side bike w/ parent/caregiver
oFoot pedal upright bike
oFoot pedal tricycle
oRecumbent bike
oHand pedal bike
**********PLEASE BRING A HELMET IF YOU HAVE ONE*************
GoBabyGo Race
*Will take place at 11:30am
(leave blank if not applicable) / __ My child has a GoBabyGo car and will be participating in the race

parent/guardian information

Name: / Date: / Email Address:
A little information about participants will help us with future program planning.
How many recreational or leisure activities does this athlete currently participate in? ______
These activities include:______
______
Did you learn about or sign up for any of the above activities from a prior Experience Fitness Project? Y N
How did you hear about the Experience Fitness Project? (check all that apply) / ___ Attended in previous year(s)
___ Friend/Family member
___ Parent support group
___ Waypoint PT Facebook Page
___ Waypoint PT Website
___ Waypoint PT Email
___ Another organization’s website or social media
___ My child’s therapist (physical, occupational, speech)
___ Other (please specify):

Liability and signature

* Any athlete borrowing a bike from Outdoors for All will need to complete a pre-race safety check.
**Efforts will be made to have sufficient equipment on hand for all requests, but availability
will be managed on a first come, first served basis.

PARTICIPANT RELEASE OF LIABILITY AND PHOTO RELEASE–I understand that the above registered participant is taking part in an activity that may be hazardous for the participant. In signing below, I assume risk of harm or injury which may occur to the participant as a result of participating in the Experience Fitness Project. I hereby release Life Enrichment Options, Waypoint Pediatric Therapies and Issaquah High School and its officers, volunteers, employees or agents from liability, costs and damages resulting from this individual’s participation. The participant has my consent to participate in the Experience Fitness Project and related activities. I also give my consent to have photos/videos taken, without recompense, during the races and activities and used for publicity purpose in printed or web format.

Signature of Parent/Guardian Date
(if preferred, a copy of this form can be signed in person on event day to avoid the need to print/scan)