Train In Place (TIP) Program

We look forward to having you join us to Train In Place (TIP)! The TIP Program offers a wide variety of adapted trainings for people of all ages and abilities.

The TIP Program is a currently being offered virtually, with live interactive instruction by AccesSportAmerica trainers.

Your Contact Information

First Name *

Last Name *

Email *

Nickname (if any) The maximum length for the field Nickname (if any) is 500 characters.

Address * The field Address is required.

City/Town * The field City/Town is required.

State * The field State is required.

Zip Code * The field Zip Code is required.

Email * The email field Email is required.

Preferred Phone * The phone field Preferred Phone is required.

Phone Type? * The field Phone Type? is required.

Phone 2 The field Phone 2 must be a phone number.

How heard/referred by

I am participating with: * The field I am participating with: is required.

Are you active in other AccesSport Programs? * The field Are you active in other AccesSport Programs? is required.

If yes, please tell us which one(s)

Additional Participant/Athlete Information

This information will help us to provide the best experience for the you as we adapt the program or sport. Please list all on-going medical issues, allergies, behavior issues, medications you are taking, and list any additional information that our staff should be aware of. Note there is a 5000 character limit to each question.

Athlete Date of Birth * The date field Athlete Date of Birth is required.

Athlete's primary diagnosis * The field Athlete's primary diagnosis is required.

On-going medical issues? * The field On-going medical issues? is required.

Allergies? * The field Allergies? is required.

Please list any allergies * The field Please list any allergies is required.

Behavioral Issues * The field Behavioral Issues is required.

Medication * The field Medication is required.

Anything else? The maximum length for the field Anything else? is 5000 characters.

When participating in the program virtually it is helpful for us to know if someone will be physically with you, either assisting wtih the exercises or somewhere else in your home.

Will someone be with you during the program? * The field Will someone be with you during the program? is required.

How often? * The field How often? is required.

Any additional information we should know? The maximum length for the field Any additional information we should know? is 500 characters.

Emergency Contacts

In the event of an emergency, these emergency contacts will be called in the order in which they appear.

Emergency Contact 1 * The field Emergency Contact 1 is required.

Preferred Phone * The field Preferred Phone is required.

Phone Type? * The field Phone Type? is required.

Can receive texts? * The field Can receive texts? is required.

Email The field Email must be an email.

Relationship to Athlete * The field Relationship to Athlete is required.

Emergency Contact 2 The maximum length for the field Emergency Contact 2 is 500 characters.

Preferred Phone The field Preferred Phone must be a phone number.

Phone Type?

Can receive texts?

Relationship to Athlete

Emergency Contact 3 The maximum length for the field Emergency Contact 3 is 500 characters.

Preferred Phone The field Preferred Phone must be a phone number.

Phone Type?

Can receive texts?

Relationship to Athlete

Billing Information

If you are participating as part of a day or residential progam you may skip the billing section.

Is billing address different from address above?

Billing Address The maximum length for the field Billing Address is 500 characters.

Billing City/Town The maximum length for the field Billing City/Town is 500 characters.

Billing State

Billing Zip The maximum length for the field Billing Zip is 500 characters.

Billing Phone The field Billing Phone must be a phone number.