Spokane WA PDW VA ASG Event Registration General InformationPre-Event SurveySTRIVE4YOU Standard Waiver & Release STRIVE4YOU Participant Code of Conduct Choose Event you are registering for- Select -Baltimore Seed level 2NC ASD & SEED WorkshopsFirst NameLast NameEmailPhone/MobileAre you a Veteran? Yes NoAddressCityStateZip CodeDate of BirthPlease choose your preferred Pronouns He/Him She/Her They/Them Prefer not to answerAre you a : person with a disability Family Member of a person with a disability Professional working with a person with a disability If you choose a person with a disability or a Family member, please share with us more about your disability.If you choose Professional what is your occupation?Agency Name?Are you requesting ACVREP CEU hours? Yes NoWe will be providing lunch for this event! Please let us know if you have any food allergies or food restrictions.Do you require any special assistance? PreviousNextPre-SurveyWe collect this information for quality control and grant purposes.1. I would rate my overall knowledge of Adaptive sports & recreational activities for people with disability as:2. My current involvement in adaptive recreation & sporting activities as a participant or facilitator is:3. My knowledge of recreational and/or sporting opportunities for people with disabilities within my community4. (For People with Disabilities Only) On a weekly bases, I would consider my physical activity level to be:5. (For people with A Disability ONLY)I consider my overall health to be: PreviousNextSTRIVE4YOU Standard WaiverIn consideration of participating in a STRIVE4You event , I, the undersigned, freely understand and acknowledge that my participation may involve physical contact which might result in serious injury or death. I agree: To comply with the terms and conditions for participation. If I encounter any hazard, whether from myself or from others, during my participation in the STRIVE4You event, I agree to withdraw from participation, alert a STRIVE4You representative of my withdrawal and remove myself from participation. To indemnify and hold STRIVE4You its Director, its Coaches and its partners , harmless from any and all injuries I may incur while participating. To grant all right, title and interest in and to my name, image, voice or statement, including any and all photographic images, audio or video recordings captured during the STRIVE4You event. I certify that I am in good physical health and have no disclosed or undisclosed conditions or injuries that would impact upon, impair or prevent my participation in the STRIVE4You event beyond reasonable accommodations. In the event I am injured during the course of the STRIVE4You event , I consent to being medically attended or treated by a physician, a nurse, athletic trainer, or other medical emergency personnel. I have read and agree to the STRIVE4You Waiver and ReleasePreviousNextParticipant Code of Conduct STRIVE4You is a community-based organization dedicated to providing education, resources, and opportunities to people with disabilities and those that interact with them within the community. Participation in STRIVE4You’s programs is subject to the observance of the organization’s rules and procedures. The activities outlined below are strictly prohibited. Any participant or staff member who violates this Code is subject to discipline, up to and including immediate removal from the event or program. Abusive language towards a staff member, volunteer, or another participant. Possession or use of alcoholic beverages or illegal drugs while attending a STRIVE4You event. Or reporting to an event while under the influence of drugs or alcohol. Bringing onto the property of STRIVE4You or it’s partner’s property dangerous or unauthorized materials such as explosives, firearms, weapons, or other similar items. Discourtesy or rudeness to a fellow participant, staff member, or volunteer. Verbal, physical, or visual harassment of another participant, staff member, or volunteer. Actual or threatened violence toward any individual or group. Conduct endangering the life, safety, health, or well-being of others. Failure to follow any agency policy or procedure. Bullying or taking unfair advantage of any participant. I have read and I understand STRIVE4You’s Participant Code of Conduct. I agree to abide by the rules described above and understand that I may be removed as a participant and face criminal prosecution if I violate any of these rules. I have read and agree with Participant Code of ConductEletronic SignatureBy typing your full name and the date in the edit box below you acknowledge that you have read and understand the waiver and the code of conduct. Please type your name and the date in the text field below.Type Full Name and Date Previous Submit Form + Add to Google Calendar + iCal / Outlook export Date Jan 13 2022 Expired! Time 9:00 am - 3:30 pm Category ARISE Professional Development Workshops Share this event