STRIVER Day 2024 Registration STRIVER Day Participant RegistrationΔ Newsletter First NameLast NameEmailPhone/MobileUnited States+1United Kingdom+44Afghanistan (افغانستان)+93Albania (Shqipëri)+355Algeria (الجزائر)+213American Samoa+1Andorra+376Angola+244Anguilla+1Antigua and Barbuda+1Argentina+54Armenia (Հայաստան)+374Aruba+297Ascension Island+247Australia+61Austria (Österreich)+43Azerbaijan (Azərbaycan)+994Bahamas+1Bahrain (البحرين)+973Bangladesh (বাংলাদেশ)+880Barbados+1Belarus (Беларусь)+375Belgium (België)+32Belize+501Benin (Bénin)+229Bermuda+1Bhutan (འབྲུག)+975Bolivia+591Bosnia and Herzegovina (Босна и Херцеговина)+387Botswana+267Brazil (Brasil)+55British Indian Ocean Territory+246British Virgin Islands+1Brunei+673Bulgaria (България)+359Burkina Faso+226Burundi (Uburundi)+257Cambodia (កម្ពុជា)+855Cameroon (Cameroun)+237Canada+1Cape Verde (Kabu Verdi)+238Caribbean Netherlands+599Cayman Islands+1Central African Republic (République centrafricaine)+236Chad (Tchad)+235Chile+56China (中国)+86Christmas Island+61Cocos (Keeling) Islands+61Colombia+57Comoros (جزر القمر)+269Congo (DRC) (Jamhuri ya Kidemokrasia ya Kongo)+243Congo (Republic) (Congo-Brazzaville)+242Cook Islands+682Costa Rica+506Côte d’Ivoire+225Croatia (Hrvatska)+385Cuba+53Curaçao+599Cyprus (Κύπρος)+357Czech Republic (Česká republika)+420Denmark (Danmark)+45Djibouti+253Dominica+1Dominican Republic (República Dominicana)+1Ecuador+593Egypt (مصر)+20El Salvador+503Equatorial Guinea (Guinea Ecuatorial)+240Eritrea+291Estonia (Eesti)+372Eswatini+268Ethiopia+251Falkland Islands (Islas Malvinas)+500Faroe Islands (Føroyar)+298Fiji+679Finland (Suomi)+358France+33French Guiana (Guyane française)+594French Polynesia (Polynésie française)+689Gabon+241Gambia+220Georgia (საქართველო)+995Germany (Deutschland)+49Ghana (Gaana)+233Gibraltar+350Greece (Ελλάδα)+30Greenland (Kalaallit Nunaat)+299Grenada+1Guadeloupe+590Guam+1Guatemala+502Guernsey+44Guinea (Guinée)+224Guinea-Bissau (Guiné Bissau)+245Guyana+592Haiti+509Honduras+504Hong Kong (香港)+852Hungary (Magyarország)+36Iceland (Ísland)+354India (भारत)+91Indonesia+62Iran (ایران)+98Iraq (العراق)+964Ireland+353Isle of Man+44Israel (ישראל)+972Italy (Italia)+39Jamaica+1Japan (日本)+81Jersey+44Jordan (الأردن)+962Kazakhstan (Казахстан)+7Kenya+254Kiribati+686Kosovo+383Kuwait (الكويت)+965Kyrgyzstan (Кыргызстан)+996Laos (ລາວ)+856Latvia (Latvija)+371Lebanon (لبنان)+961Lesotho+266Liberia+231Libya (ليبيا)+218Liechtenstein+423Lithuania (Lietuva)+370Luxembourg+352Macau (澳門)+853Madagascar (Madagasikara)+261Malawi+265Malaysia+60Maldives+960Mali+223Malta+356Marshall Islands+692Martinique+596Mauritania (موريتانيا)+222Mauritius (Moris)+230Mayotte+262Mexico (México)+52Micronesia+691Moldova (Republica Moldova)+373Monaco+377Mongolia (Монгол)+976Montenegro (Crna Gora)+382Montserrat+1Morocco (المغرب)+212Mozambique (Moçambique)+258Myanmar (Burma) (မြန်မာ)+95Namibia (Namibië)+264Nauru+674Nepal (नेपाल)+977Netherlands (Nederland)+31New Caledonia (Nouvelle-Calédonie)+687New Zealand+64Nicaragua+505Niger (Nijar)+227Nigeria+234Niue+683Norfolk Island+672North Korea (조선 민주주의 인민 공화국)+850North Macedonia (Северна Македонија)+389Northern Mariana Islands+1Norway (Norge)+47Oman (عُمان)+968Pakistan (پاکستان)+92Palau+680Palestine (فلسطين)+970Panama (Panamá)+507Papua New Guinea+675Paraguay+595Peru (Perú)+51Philippines+63Poland (Polska)+48Portugal+351Puerto Rico+1Qatar (قطر)+974Réunion (La Réunion)+262Romania (România)+40Russia (Россия)+7Rwanda+250Saint Barthélemy+590Saint Helena+290Saint Kitts and Nevis+1Saint Lucia+1Saint Martin (Saint-Martin (partie française))+590Saint Pierre and Miquelon (Saint-Pierre-et-Miquelon)+508Saint Vincent and the Grenadines+1Samoa+685San Marino+378São Tomé and Príncipe (São Tomé e Príncipe)+239Saudi Arabia (المملكة العربية السعودية)+966Senegal (Sénégal)+221Serbia (Србија)+381Seychelles+248Sierra Leone+232Singapore+65Sint Maarten+1Slovakia (Slovensko)+421Slovenia (Slovenija)+386Solomon Islands+677Somalia (Soomaaliya)+252South Africa+27South Korea (대한민국)+82South Sudan (جنوب السودان)+211Spain (España)+34Sri Lanka (ශ්රී ලංකාව)+94Sudan (السودان)+249Suriname+597Svalbard and Jan Mayen+47Sweden (Sverige)+46Switzerland (Schweiz)+41Syria (سوريا)+963Taiwan (台灣)+886Tajikistan+992Tanzania+255Thailand (ไทย)+66Timor-Leste+670Togo+228Tokelau+690Tonga+676Trinidad and Tobago+1Tunisia (تونس)+216Turkey (Türkiye)+90Turkmenistan+993Turks and Caicos Islands+1Tuvalu+688U.S. Virgin Islands+1Uganda+256Ukraine (Україна)+380United Arab Emirates (الإمارات العربية المتحدة)+971United Kingdom+44United States+1Uruguay+598Uzbekistan (Oʻzbekiston)+998Vanuatu+678Vatican City (Città del Vaticano)+39Venezuela+58Vietnam (Việt Nam)+84Wallis and Futuna (Wallis-et-Futuna)+681Western Sahara (الصحراء الغربية)+212Yemen (اليمن)+967Zambia+260Zimbabwe+263Åland Islands+358AddressCityStateZip CodeDate of BirthChoose Admission Type 1 Veteran Admission 1 VA Staff Admission 1 Care Giver (of Veteran)Admission 1 Child Admission (5 & under) 1 General Admission 1Professional Admission (Seeking CEU) Family Admission (4 or less)Additional Participant InformationWe want to make sure we track all participants. And have enough food for everyone as well. Please be sure to give us the full names and ages of all participants coming.Full Name Date of BirthDoes the participant have a disability? Yes NoFull NameDate of BirthDoes the participant have a disability? Yes NoFull Name Date of BirthDoes the participant have a disability? Yes NoCheck all that apply. Person with Disability Family Member of a Person with a Disability Veteran VA Staff Care Giver Care Giver of a VeteranIf you choose a person with a disability or a Family member, please share with us more about your disability.Meal OptionsFriday night we will be hosting a reception for anyone wanting to attend. Saturday during the event we will also offer lunch. We need to know from you if you will be attending them or not. And lastly , if you have any allergies, intolerances, or food restrictions. Will you attend Friday night reception? Yes NoWill you attend the lunch during the Saturday event? Yes NoDo you have any food allergies, intolerances, or restrictions.Please let us know if any of the following will help you enjoy your STRIVER Day Experience? A Guide A Translator ASL Interpreter Electronic Large Print Braille Other, please explain below.If other was chosen above pelase explain.Language?Payment SectionPlease select the correct payment items for your admission.Promo CodeApply CouponNo payment items has been selected yetPayment Method Pay with Card (Stripe) Pay with PayPalPay with Card (Stripe)STRIVE4YOU 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 ReleaseParticipant 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 DateSubmit Form