First Name

Last Name

Commonly Used First Name (nickname)

Gender - Select One - Female Male Non-binary Prefer not to disclose

Do you identify as 2SLGBTQI+? - Select One - Yes No Prefer not to disclose

What is your race: (select what is applicable)

Do you identify as First Nations, Métis and/or Inuk/Inuit? (Select what is applicable)

Are you a person living with disability? - Select One - Yes No Prefer not to disclose

What type of disability are you currently living with? - Select One - Prefer not to disclose Physical Mental Sensory Other

Impairment types that can be classified for Para Rowing. Select what is applicable Ataxia Atheosis Hypertonia Impaired muscle power Impaired range of movement Limb deficiency Other Vision impairment

Para-Rowing Classifications - Select One - PR1 PR2 PR3 I have not received an official classification

International Blind Sports Classification - Select One - B1 B2 B3 I have not received an official classification

Date of Birth

Date of Birth

Date of Birth