Adapted Obstacle Course Registration

Participant Information

Full Name: *

Preferred Name: *

Address: *

City: *

State: *

Zip Code: *

Email Address: *

Phone: *

Age: *

Participant T-Shirt Size: *

In order to by guaranteed a t-shirt in your size, all paper registration forms are due by Friday, July 31.

Small Medium Large XL 2XL 3XL

Emergency Contact Information

Full Name: *

Relationship to Participant: *

Email Address: *

Phone: *

Course Completion Questions

Are you doing the course with a group or friend who is also participating? If yes, provide their name to be placed in a similar wave time:

How will you be completing the course?: *

My Own Power Wheel Chair My Own Manual Wheel Chair Ambulatory (not using a wheel chair) Other

If you chose other in the previous question, please elaborate:

Course Companions: *

Participants can bring their own able-bodied Course Companion to assist with obstacles (and fun) on the course. This person must be 18+ and is required to sign a waiver at registration. If you do not have a companion, one will be provided for you. We require that every participant have a parent/guardian/staff present at the event. This can (but doesn’t have to) be the same person as the Course Companion.

I will bring my own Course Companion
I will need my own Course Companion

Full Name: *

Phone: *

Lake Erie Odyssey - Registration

Participant Information

Emergency Contact Information

Course Completion Questions

By clicking SUBMIT below, you will be redirected to sign the waiver

Latest News

Barber National Institute announces Lake Erie Odyssey, a new adapted obstacle course event

A Focus on Functional Living Skills

Barber National Institute, LECOM Behavioral Health take coordinated action to strengthen services

Locations

Lake Erie Odyssey - Registration

Participant Information

Emergency Contact Information

Course Completion Questions

By clicking SUBMIT below, you will be redirected to sign the waiver

Latest News

Barber National Institute announces Lake Erie Odyssey, a new adapted obstacle course event

A Focus on Functional Living Skills

Barber National Institute, LECOM Behavioral Health take coordinated action to strengthen services

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