Registration: Chicago Half Marathon 2018 - CAPTAINS

Please note that registering as a Captain does not register you for the race. This registers a Captain to participate in the race with my TEAM TRIUMPH Chi-Town.

We will register and cover the race fee for all Captains.

USER INFORMATION
First Name:
Last Name:
Address:
City:
State:
Zip:
Email:
Confirm Email:
Phone:
Gender:
Male  Female  
Date of Birth:
   
Shirt Size:
S  M  L  XL  2XL  
Primary diagnoses/injuries that resulted in your disability & any other pertinent information:
How long have you had your disability:
Since Birth  More than 1 Year ago  Less than 1 Year  
Type of assistive device used:
None Needed  Cane  Crutches  Walker  Wheelchair  
Ability to use a wheelchair:
None Needed  Independent Manual  Independent Electric  Unable  
1
Transfer Ability:
Independent  Requires Min Assist  Mod Assist  Max Assist  
Do you have a history of seizures? (Y/N):
Yes  No  
Are you continent:
Yes  No  
Would you require any special feeding during the race:
Yes  No  
Height:
Weight:
Person Completing Registration:
Relationship to Captain:
Enter the Security Code:
I agree to the terms and conditions:
Read Terms & Conditions