Hikeabilities OT, LLC
Hike & Roll - Adaptive Hiking Event 10/4/26
Tyler State Park - Bucks County, PA
Parent/Caregiver
*
First Name
Last Name
Child
*
First Name
Last Name
Child's Age
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What type of mobility device does your child use?
*
Please Select
Wheelchair (manual)
Wheelchair (power)
Walker/rollator
Other
What size t-shirt does your child wear?
*
Please Select
YXS
YS
YM
YL
YXL
AS
AM
AL
AXL
AXXL
Please check the following.
*
I understand that I am required to attend the full event with my child.
Does your child need any specialized support? If so, please describe below.
If any siblings will be attending, please indicate how many.
How did you learn about Hikeabilities and the Hike & Roll event?
*
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Hike & Roll (Participant & Family)
$49.00
$
49.00
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