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Name

Age group

Location

Number of years disabled

Do you have any physical disabilities that would prevent you from safely operating an electric wheelchair?

Do you have any prior experience racing electric wheelchairs or operating mobility devices?

Do you have the necessary equipment and protective gear, such as a helmet and elbow and knee pads?

Have you received any safety training or instruction on how to properly operate an electric wheelchair?

Are you familiar with the rules and guidelines for the race, and do you agree to follow them?

Do you have any medical conditions or allergies that we should be aware of in case of an emergency?

Are you a member of any of these organizations?

- [ ] Wounded Warriors

- [ ] Special Olympics

- [ ] American veterans