• Sports Association Member Profile

  • Welcome to the Gaylord Sports Association!

    The Gaylord Sports Association is a program of Gaylord Specialty Healthcare, based in Wallingford, CT.  We have been dedicated to helping people with a physical disability or visual impairment to experience the benefits of sports and recreation for over 20 years!  By completing this member profile form, you will be joining the program and sharing information about yourself so that we can learn about you and how we can help you reach your adaptive sports goals! If you haven't already met with us, we'll contact you after we recieve this form with the next steps on how to get started! 

    If you have any questions, we can be reached at 203-284-2772 or sports@gaylord.org.  Additional information about the Gaylord Sports Association can be found on our webpage at www.gaylord.org/sports.

    -The Sports Association Team

    Katie Joly, Sports Association Program Manager

    Debbie Gibilaro, Adaptive Sports Program Specialist

    Katie Butler, Adaptive Sports Program Specialist

  • CONTACT INFORMATION

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  • MILITARY INFORMATION

  • BACKGROUND INFORMATION & INTERESTS

  • MEDICAL INFORMATION

  • The Gaylord Sports Association serves individuals with a physical disability or visual impairment ages 16 and up. 

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  • FUNCTIONAL ABILITIES

  • ACTIVITY LEVEL

  • ACKNOWLEDGEMENT

  • By signing below, I verify that the above information is current and accurate. I understand that the above information will be kept confidential. In order to provide a safe and fun experience, your information may be shared with: (1) Sports Association staff, coaches or instructors, (2)other adaptive sports programs who will be working with you, (3)medical professionals in case of emergency, (4) as required for Sports Association grant reports. I understand that it is my responsibility to inform the Sports Association regarding changes to my:(1) contact information such as address, phone, and email: (2) medical status including new diagnosis, surgery or medical changes; (3) any other information that is relevant to the safety of myself or others regarding my participation in Sports Association programs.

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  • Liability & Media Waiver

  • All participants, volunteers, and coaches must sign an annual liability waiver and optional media release. Once this form is submitted, please follow the instructions provided to sign the online waiver.

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