Gaylord Gauntlet Athlete Sponsorship Application

This application is for adaptive athletes applying for sponsorship to the 2022 Gaylord Gauntlet being held on June 25, 2022 in Wallingford, CT. This application is due by April 30, 2022. Two athletes will be selected for this sponsorship. Additional information on eligibility for this sponsorship and what will be provided can be found at www.gaylordgauntlet.org under Race Info - Adaptive Athletes Information. If you would like to apply, please complete the following application. If you have questions, we can be reached at sports@gaylord.org or 203-284-2772.

I am applying for the Gaylord Gauntlet Adaptive Athlete Sponsorship. *

Yes

Applicant must meet all 4 of the following eligibility requirements. Applicants must reside outside of CT to be eligible for this sponsorship. Please indicate your eligibility by checking all that apply. *

I am an adaptive athlete with a physical disability or visual impairment I will be at least 16 years of age at the time of the Gaylord Gauntlet on June 25, 2022. I do NOT reside in CT I am ready to take on the challenge of the Gaylord Gauntlet!

Full Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

E-mail *

example@example.com

Date of Birth *

Month Day Year

Are you a veteran?

Yes No

What is your service branch?

Please select: *

I am over the age of 18 and can legally sign for myself. I am either under the age of 18, legally conserved or not my own guardian.

Name of Legal Guardian or Conservator

First Name Last Name

Phone Number of Legal Guardian

Please enter a valid phone number.

Relationship to Legal Guardian

What is your primary diagnosis? *

What is your secondary diagnosis (if applicable)?

Please indicate if you have any of the below conditions? *

If any of the above apply, please provide additional information here. Or, please make any additional comments about your disability or medical history that we should be aware of:

Are you able to provide medical clearance from a doctor for your participation if requested? *

Yes No

Gaylord Gauntlet - Adaptive Athlete Sponsorship Application

Eligibility Questions

Applicant Information

Sponsorship Information

Relevant Experience

Race Information

Acknowledgment