Regional Games Entry Form
TRISTATE WHEELCHAIR ATHLETICS ASSOCIATION
Registration for
Athlete
Coach
Assistant Coach
Parent
Volunteer
Official
WC-wheelchair CP-cerebal palsey DS-amputee BA-blind DA-dwarf
DSO membershipType
WC
CP
DS
BA
DA
OT
First Name
Last Name
MM/DD/YYYY
Date of Birth
_
Male
Female
Address
Gender
Age Division
_
A
B
C
D
E
Adults
Masters
Address2
Zip code
USA
CAN
AUS
GBR
City
State
Country
Home Phone
Cell
E-mail
T-Shirt Size
Membership Number
Head Coach
Team Name
Coach
Work Phone
Coach E-mail
Coach
Home Phone
Needs to be Classified ?
Classification site
_
Yes
No
Classified by whom
Sanctioned Meet
Is Coach coming to meet ?
_
Yes
No
Sport Certifications
_
Yes
No
Arrival shuttle
_
Yes
No
Departure shuttle
Need shuttle from
Need equiptment help?
_
Yes
No
_
Team
Family
Arrival Airline
Traveling with
Departure Airline
Arrival Flight
Number extra chairs
Number of People
Departure Flight
Arrival Date
Departure Date
Lodging
Arrival Time
Departure Time
Lodging Checkin date
Lodging checkout date
No
Yes
Yes
No
Need accessible room
Stay at host hotel ?
Registration Fee $
Number of Additional Banquet Tickets
A
B
D
Meal Plan A or B
C
B
A
Number of Banquet Meal Choices
ARCHERY
_
AR1
AR2
AR3
Recurve
Compound
_
No
Yes
Classification
Type Bow
Use Bowstand
_
Novice Cadet
Cadet
Junior
Intermediate
Advanced Intermediate
Archery Event
Qualifying Mark
TRACK
_
T11
T12
T13
T31
T32
T32L
T32U
T33
T34
T35
T35a
T35b
T36
RR1
RR2
RR3
RR4
RR5
T40
T41-42
T43-44
T45-46
T51
T52
T53
T54
_
Classification
_
100 Meters
200 Meters
400 Meters
800 Meters
1500 Meters
5000 Meters
10000 Meters
20 Meters
60 Meters
60 Meter Weave
Track Event
Track Event
_
100 Meters
200 Meters
400 Meters
800 Meters
1500 Meters
5000 Meters
10000 Meters
20 Meters
60 Meters
60 Meter Weave
Qualifying Mark
Qualifying Mark
_
100 Meters
200 Meters
400 Meters
800 Meters
1500 Meters
5000 Meters
10000 Meters
20 Meters
60 Meters
60 Meter Weave
Track Event
Track Event
_
100 Meters
200 Meters
400 Meters
800 Meters
1500 Meters
5000 Meters
10000 Meters
20 Meters
60 Meters
60 Meter Weave
Qualifying Mark
Qualifying Mark
_
100 Meters
200 Meters
400 Meters
800 Meters
1500 Meters
5000 Meters
10000 Meters
20 Meters
60 Meters
60 Meter Weave
Track Event
Track Event
_
100 Meters
200 Meters
400 Meters
800 Meters
1500 Meters
5000 Meters
10000 Meters
20 Meters
60 Meters
60 Meter Weave
Qualifying Mark
Qualifying Mark
_
100 Meters
200 Meters
400 Meters
800 Meters
1500 Meters
5000 Meters
10000 Meters
20 Meters
60 Meters
60 Meter Weave
Track Event
Track Event
_
100 Meters
200 Meters
400 Meters
800 Meters
1500 Meters
5000 Meters
10000 Meters
20 Meters
60 Meters
60 Meter Weave
Qualifying Mark
Qualifying Mark
Track Relay
Relay letter
Qualifying Mark
Points
Gender
Alternate
Relay Team Name
_
4 x 100
800 Medlay
_
10
20
30
40
_
Male
Female
Mixed_
A
B
C
D
E
F
G
H
_
Alt
_
4 x 100
800 Medlay
_
10
20
30
40
_
Male
Female
Mixed
A
B
C
D
E
F
G
H
_
Alt
FIELD
Field Class
Discus Class
Javelin Class
_
F11
F12
F13
F31
F32
F32U
F32L
F33
F34
F35
F35a
F35b
F36
F37
F38
F40
F41
F42
F43
F44
F45
F46
F51
F52
F53
F54
F55
F56
F57
F58
_
F11
F12
F13
F31
F32
F32U
F32L
F33
F34
F35
F35a
F35b
F36
F37
F38
F40
F41
F42
F43
F44
F45
F46
F51
F52
F53
F54
F55
F56
F57
F58
_
F11
F12
F13
F31
F32
F32U
F32L
F33
F34
F35
F35a
F35b
F36
F37
F38
F40
F41
F42
F43
F44
F45
F46
F51
F52
F53
F54
F55
F56
F57
F58
Classification
_
ShotPut
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Jump
Precision
High Toss
Hammer
Weight throw
SpungDisc
Thrust Kick
Distance Kick
Tennis Ball Throw
Softball Throw
Medicine Ball Thrust
Distance Toss
Pentathlon
_
Field Event
_
ShotPut
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Jump
Precision
High Toss
Hammer
Weight throw
SpungDisc
Thrust Kick
Distance Kick
Tennis Ball Throw
Softball Throw
Medicine Ball Thrust
Distance Toss
Pentathlon
_
Field Event
Qualifying Mark
Qualifying Mark
_
ShotPut
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Jump
Precision
High Toss
Hammer
Weight throw
SpungDisc
Thrust Kick
Distance Kick
Tennis Ball Throw
Softball Throw
Medicine Ball Thrust
Distance Toss
Pentathlon
_
Field Event
Field Event
_
ShotPut
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Jump
Precision
High Toss
Hammer
Weight throw
SpungDisc
Thrust Kick
Distance Kick
Tennis Ball Throw
Softball Throw
Medicine Ball Thrust
Distance Toss
Pentathlon
_
Qualifying Mark
Qualifying Mark
_
ShotPut
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Jump
Precision
High Toss
Hammer
Weight throw
SpungDisc
Thrust Kick
Distance Kick
Tennis Ball Throw
Softball Throw
Medicine Ball Thrust
Distance Toss
Pentathlon
_
Field Event
Field Event
_
ShotPut
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Jump
Precision
High Toss
Hammer
Weight throw
SpungDisc
Thrust Kick
Distance Kick
Tennis Ball Throw
Softball Throw
Medicine Ball Thrust
Distance Toss
Pentathlon
_
Qualifying Mark
Qualifying Mark
_
ShotPut
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Jump
Precision
High Toss
Hammer
Weight throw
SpungDisc
Thrust Kick
Distance Kick
Tennis Ball Throw
Softball Throw
Medicine Ball Thrust
Distance Toss
Pentathlon
_
Field Event
Field Event
_
ShotPut
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Jump
Precision
High Toss
Hammer
Weight throw
SpungDisc
Thrust Kick
Distance Kick
Tennis Ball Throw
Softball Throw
Medicine Ball Thrust
Distance Toss
Pentathlon
_
Qualifying Mark
Qualifying Mark
Swimming
Swim Class
Breast Stroke
Medley
_
SM1
SM2
SM3
SM4
SM5
SM6
SM7
SM8
SM9
SM10
SM11
SM12
SM13
_
S1
S2
S3
S4
S5
S6
S7
S8
S9
S10
S11
S12
S13
_
SB1
SB2
SB3
SB4
SB5
SB6
SB7
SB8
SB9
SB10
SB11
SB12
SB13
Classification
_
25 Yd free
25 M free
50 Yd free
50 M free
100 Yd free
100 M free
200 Yd free
200 M free
500 Yd free
500 M free
25 Yd back
25 M back
50 Yd back
50 M back
100 Yd back
100 M backs
25 Yd breast
25 M breast
50 Yd breast
50 M breast
100 Yd breast
100 M breast
25 Yd fly
25 M fly
50 Yd fly
50 M fly
100 Yd fly
100 M fly
3 x 25 Yd IM
3 x 25 M IM
4 x 25 Yd IM
4 x 25 M IM
3 x 50 Yd IM
3 x 50 M IM
4 x 50 Yd IM
4 x 50 M IM
50 Yd open free
50 M open free
100 Yd open free
100 M open free
200 Yd open free
200 M open free
Swim Event
Swim Event
_
25 Yd free
25 M free
50 Yd free
50 M free
100 Yd free
100 M free
200 Yd free
200 M free
500 Yd free
500 M free
25 Yd back
25 M back
50 Yd back
50 M back
100 Yd back
100 M backs
25 Yd breast
25 M breast
50 Yd breast
50 M breast
100 Yd breast
100 M breast
25 Yd fly
25 M fly
50 Yd fly
50 M fly
100 Yd fly
100 M fly
3 x 25 Yd IM
3 x 25 M IM
4 x 25 Yd IM
4 x 25 M IM
3 x 50 Yd IM
3 x 50 M IM
4 x 50 Yd IM
4 x 50 M IM
50 Yd open free
50 M open free
100 Yd open free
100 M open free
200 Yd open free
200 M open free
Qualifying Mark
Qualifying Mark
_
25 Yd free
25 M free
50 Yd free
50 M free
100 Yd free
100 M free
200 Yd free
200 M free
500 Yd free
500 M free
25 Yd back
25 M back
50 Yd back
50 M back
100 Yd back
100 M backs
25 Yd breast
25 M breast
50 Yd breast
50 M breast
100 Yd breast
100 M breast
25 Yd fly
25 M fly
50 Yd fly
50 M fly
100 Yd fly
100 M fly
3 x 25 Yd IM
3 x 25 M IM
4 x 25 Yd IM
4 x 25 M IM
3 x 50 Yd IM
3 x 50 M IM
4 x 50 Yd IM
4 x 50 M IM
50 Yd open free
50 M open free
100 Yd open free
100 M open free
200 Yd open free
200 M open free
Swim Event
Swim Event
_
25 Yd free
25 M free
50 Yd free
50 M free
100 Yd free
100 M free
200 Yd free
200 M free
500 Yd free
500 M free
25 Yd back
25 M back
50 Yd back
50 M back
100 Yd back
100 M backs
25 Yd breast
25 M breast
50 Yd breast
50 M breast
100 Yd breast
100 M breast
25 Yd fly
25 M fly
50 Yd fly
50 M fly
100 Yd fly
100 M fly
3 x 25 Yd IM
3 x 25 M IM
4 x 25 Yd IM
4 x 25 M IM
3 x 50 Yd IM
3 x 50 M IM
4 x 50 Yd IM
4 x 50 M IM
50 Yd open free
50 M open free
100 Yd open free
100 M open free
200 Yd open free
200 M open free
Qualifying Mark
Qualifying Mark
_
25 Yd free
25 M free
50 Yd free
50 M free
100 Yd free
100 M free
200 Yd free
200 M free
500 Yd free
500 M free
25 Yd back
25 M back
50 Yd back
50 M back
100 Yd back
100 M backs
25 Yd breast
25 M breast
50 Yd breast
50 M breast
100 Yd breast
100 M breast
25 Yd fly
25 M fly
50 Yd fly
50 M fly
100 Yd fly
100 M fly
3 x 25 Yd IM
3 x 25 M IM
4 x 25 Yd IM
4 x 25 M IM
3 x 50 Yd IM
3 x 50 M IM
4 x 50 Yd IM
4 x 50 M IM
50 Yd open free
50 M open free
100 Yd open free
100 M open free
200 Yd open free
200 M open free
_
25 Yd free
25 M free
50 Yd free
50 M free
100 Yd free
100 M free
200 Yd free
200 M free
500 Yd free
500 M free
25 Yd back
25 M back
50 Yd back
50 M back
100 Yd back
100 M backs
25 Yd breast
25 M breast
50 Yd breast
50 M breast
100 Yd breast
100 M breast
25 Yd fly
25 M fly
50 Yd fly
50 M fly
100 Yd fly
100 M fly
3 x 25 Yd IM
3 x 25 M IM
4 x 25 Yd IM
4 x 25 M IM
3 x 50 Yd IM
3 x 50 M IM
4 x 50 Yd IM
4 x 50 M IM
50 Yd open free
50 M open free
100 Yd open free
100 M open free
200 Yd open free
200 M open free
Swim Event
Swim Event
Qualifying Mark
Qualifying Mark
_
25 Yd free
25 M free
50 Yd free
50 M free
100 Yd free
100 M free
200 Yd free
200 M free
500 Yd free
500 M free
25 Yd back
25 M back
50 Yd back
50 M back
100 Yd back
100 M backs
25 Yd breast
25 M breast
50 Yd breast
50 M breast
100 Yd breast
100 M breast
25 Yd fly
25 M fly
50 Yd fly
50 M fly
100 Yd fly
100 M fly
3 x 25 Yd IM
3 x 25 M IM
4 x 25 Yd IM
4 x 25 M IM
3 x 50 Yd IM
3 x 50 M IM
4 x 50 Yd IM
4 x 50 M IM
50 Yd open free
50 M open free
100 Yd open free
100 M open free
200 Yd open free
200 M open free
_
25 Yd free
25 M free
50 Yd free
50 M free
100 Yd free
100 M free
200 Yd free
200 M free
500 Yd free
500 M free
25 Yd back
25 M back
50 Yd back
50 M back
100 Yd back
100 M backs
25 Yd breast
25 M breast
50 Yd breast
50 M breast
100 Yd breast
100 M breast
25 Yd fly
25 M fly
50 Yd fly
50 M fly
100 Yd fly
100 M fly
3 x 25 Yd IM
3 x 25 M IM
4 x 25 Yd IM
4 x 25 M IM
3 x 50 Yd IM
3 x 50 M IM
4 x 50 Yd IM
4 x 50 M IM
50 Yd open free
50 M open free
100 Yd open free
100 M open free
200 Yd open free
200 M open free
Swim Event
Swim Event
Qualifying Mark
Qualifying Mark
_
25 Yd free
25 M free
50 Yd free
50 M free
100 Yd free
100 M free
200 Yd free
200 M free
500 Yd free
500 M free
25 Yd back
25 M back
50 Yd back
50 M back
100 Yd back
100 M backs
25 Yd breast
25 M breast
50 Yd breast
50 M breast
100 Yd breast
100 M breast
25 Yd fly
25 M fly
50 Yd fly
50 M fly
100 Yd fly
100 M fly
3 x 25 Yd IM
3 x 25 M IM
4 x 25 Yd IM
4 x 25 M IM
3 x 50 Yd IM
3 x 50 M IM
4 x 50 Yd IM
4 x 50 M IM
50 Yd open free
50 M open free
100 Yd open free
100 M open free
200 Yd open free
200 M open free
Qualifying Mark
Swim Event
Swim Event
_
25 Yd free
25 M free
50 Yd free
50 M free
100 Yd free
100 M free
200 Yd free
200 M free
500 Yd free
500 M free
25 Yd back
25 M back
50 Yd back
50 M back
100 Yd back
100 M backs
25 Yd breast
25 M breast
50 Yd breast
50 M breast
100 Yd breast
100 M breast
25 Yd fly
25 M fly
50 Yd fly
50 M fly
100 Yd fly
100 M fly
3 x 25 Yd IM
3 x 25 M IM
4 x 25 Yd IM
4 x 25 M IM
3 x 50 Yd IM
3 x 50 M IM
4 x 50 Yd IM
4 x 50 M IM
50 Yd open free
50 M open free
100 Yd open free
100 M open free
200 Yd open free
200 M open free
Qualifying Mark
Relay Event
Qualifying Mark
Points
Relay letter
Gender
Relay Team Name
Alternate
_
4 X 25 Yd Medley
4 X 25 M Medley
4 X 50 Yd Medley
4 X 50 M Medley
4 X 25 Yd Free
4 X 25 M Free
4 X 50 Yd Free
4 X 50 M Free
_
10
15
20
25
30
35
_
Male
Female
Mixed
A
B
C
D
E
F
G
H
_
Alt
_
4 X 25 Yd Medley
4 X 25 M Medley
4 X 50 Yd Medley
4 X 50 M Medley
4 X 25 Yd Free
4 X 25 M Free
4 X 50 Yd Free
4 X 50 M Free
_
10
15
20
25
30
35
_
Male
Female
Mixed
A
B
C
D
E
F
G
H
_
Alt
Table Tennis
_
TT1
TT2
TT3
TT4
TT5
TT6
TT7
TT8
TT9
TT10
Classification
_
Open Novice
Singles
Open Wheelchair
Open Standup
Open Combined
Open Doubles Wheelchair
Open Doubles Standup
Open Singles
Open Doubles
_
Open Novice
Singles
Open Wheelchair
Open Standup
Open Combined
Open Doubles Wheelchair
Open Doubles Standup
Open Singles
Open Doubles
TT Event
Ranking
TT Event
Ranking
_
Open Novice
Singles
Open Wheelchair
Open Standup
Open Combined
Open Doubles Wheelchair
Open Doubles Standup
Open Singles
Open Doubles
TT Event
Ranking
Ranking
_
Open Novice
Singles
Open Wheelchair
Open Standup
Open Combined
Open Doubles Wheelchair
Open Doubles Standup
Open Singles
Open Doubles
TT Event
TT Event
_
Open Novice
Singles
Open Wheelchair
Open Standup
Open Combined
Open Doubles Wheelchair
Open Doubles Standup
Open Singles
Open Doubles
Ranking
Ranking
_
Open Novice
Singles
Open Wheelchair
Open Standup
Open Combined
Open Doubles Wheelchair
Open Doubles Standup
Open Singles
Open Doubles
TT Event
TT Event
_
Open Novice
Singles
Open Wheelchair
Open Standup
Open Combined
Open Doubles Wheelchair
Open Doubles Standup
Open Singles
Open Doubles
Ranking
Ranking
_
Open Novice
Singles
Open Wheelchair
Open Standup
Open Combined
Open Doubles Wheelchair
Open Doubles Standup
Open Singles
Open Doubles
TT Event
_
Powerlift Press
Bench press
Total
Weightlifting
Weightlifting Event
Weightlifting Event
_
Powerlift Press
Bench Press
Total
Weightlifting Event
_
Powerlift Press
Bench Press
Total
Team Sports
_
3 x 3 basketball
Team Event
Team Name
Position
_
3 x 3 basketball
Team Event
Team Name
Position
_
3 x 3 basketball
Team Event
Team Name
Position
Venue
_
_
Classification
_
Event
_
Shotput
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Toss
Precision Toss
Distance Toss
Tennis ball Throw
Distance Kick
Thrust Kick
Event
Qualifying Mark
Qualifying Mark
_
Event
Event
_
Shotput
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Toss
Precision Toss
Distance Toss
Tennis ball Throw
Distance Kick
Thrust Kick
Qualifying Mark
Qualifying Mark
Venue
_
F11
F12
F13
F31
F32
F32U
F32L
F33
F34
F35
F35a
F35b
F36
F37
F38
F40
F41
F42
F43
F44
F45
F46
F51
F52
F53
F54
F55
F56
F57
F58
F9
_
Classification
_
Shotput
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Toss
Precision Toss
Distance Toss
Tennis ball Throw
Distance Kick
Thrust Kick
Event
_
Shotput
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Toss
Precision Toss
Distance Toss
Tennis ball Throw
Distance Kick
Thrust Kick
Event
Qualifying Mark
Qualifying Mark
_
Shotput
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Toss
Precision Toss
Distance Toss
Tennis ball Throw
Distance Kick
Thrust Kick
Event
Event
_
Shotput
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Toss
Precision Toss
Distance Toss
Tennis ball Throw
Distance Kick
Thrust Kick
Qualifying Mark
Qualifying Mark
Venue
_
_
F11
F12
F13
F31
F32
F32U
F32L
F33
F34
F35
F35a
F35b
F36
F37
F38
F40
F41
F42
F43
F44
F45
F46
F51
F52
F53
F54
F55
F56
F57
F58
F9
Classification
_
Shotput
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Toss
Precision Toss
Distance Toss
Tennis ball Throw
Distance Kick
Thrust Kick
Event
_
Shotput
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Toss
Precision Toss
Distance Toss
Tennis ball Throw
Distance Kick
Thrust Kick
Event
Qualifying Mark
Qualifying Mark
_
Shotput
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Toss
Precision Toss
Distance Toss
Tennis ball Throw
Distance Kick
Thrust Kick
Event
Event
_
Shotput
Discus
Javelin
Softball
Club
Long Jump
Triple Jump
High Toss
Precision Toss
Distance Toss
Tennis ball Throw
Distance Kick
Thrust Kick
Qualifying Mark
Qualifying Mark
