INTAKE QUESTIONNAIRE

Abilities in Motion

We are so grateful you and your athlete are joining The Abilities in Motion family! Please fill out the following form thoroughly as it will help us serve your athlete best in their fitness journey.

Our mission: Our mission is to create a welcoming, inclusive environment where individuals of all abilities can experience the benefits of movement, community, and confidence. We aim to empower individuals to build strength, independence, and belonging — both inside and outside the gym.

First Name *

Last Name *

Preferred Nickname

Participant Age *

Participant Date of Birth

What type of special need does your athlete experience? *

Does your athlete experience any sensory sensitivities? *

Please list all physical activities your athlete currently participates in. *

Does your athlete have any physical limitations?

Does your athlete have any medical conditions?

Does your athlete have any allergies?

Please list any additional information about your athlete that our coaches should know:

Name of Parent/Legal Guardian *

Please note the listed guardian's relationship to athlete: *

Parent/Legal Guardian Phone Number *

Parent/Legal Guardian Email *

Photo/Video Consent

I Consent

I Do Not Consent

As the parent/legal guardian of this athlete, I grant Uniquely Abled Fitness my permission to use photographs/videos of my child for any use including, but not limited to: illustration, advertising, marketing, and web content.

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.