Get To Know You Form

Tell us about yourself

Navigating the world of adapted physical activity can be overwhelming. Calgary Adapted Hub powered by Jumpstart (CAH) is here to help. Our goal is to overcome obstacles to participation by helping you find suitable programming with ease.

Our experienced team of staff and volunteers can help you find the right program for you—but we need to know a bit about you first! The information you share will help us find reasonable and appropriate solutions in the city of Calgary.

Get the ball rolling by filling out the form or contacting us by phone or email. A member of our team will get in touch to arrange a meeting where we’ll discuss your interests and abilities.

.BackgroundPatternOne__BackgroundPatternOneStyled-sc-1ilt4m-0.hMPdPq.gbi-472006256-upx5nCqrWB6mEF1GtnMVBn:before { opacity: 1; background-image: url('/static/893f7e8a0ddae74a7263832cecfcb311/3ba25/cah-background-pattern.png'); }

Family needs Assessment Intake Form

Parent and Child Contact Information

Parent Name (required)You must input a name.

Parent email (required)The email address you entered is not valid.

Parent Phone Number (required)You must provide a valid phone number.

Child Name (required)You must provide a name for your child.

Child Age (required)You must provide an age for your child.

Child Information

What type of sport or recreation activities is your child interested in? (required)You must provide What type of sport or recreation activities is your child interested in.

What type of program(s) has your child participated in the past? (required)You must provide What type of programs has your child participated in the past.

What disabilities does your child experience? (required)You must provide What disabilities does your child experience.

What adaptations does your child need in order to be successful in an active environment? We will expand on this in our next steps, but please provide some general information to get us started. (required)You must provide What adaptations does your child need in order to be successful.

Does your child require a dedicated aide or have any medical considerations? (required)You must provide if your child requires a dedicated aide or have any medical considerations.

The Calgary Adapted Hub (CAH) powered by Jumpstart works with a research team to understand the impact of programs have on physical activity, participation, quality of life, and overall health and well-being to inform the future of adaptive and inclusive programs. Are you willing to be contacted by the CAH Research and Knowledge Translation Coordinator or a qualified research staff member completing research on behalf of the CAH?

you must agree before submitting form.Yes, I agree to be contacted by Calgary Adapted Hub

Spam Check

Which animal is larger, a mouse or a horse? (required)You must input an answer.

Calgary Adapted Hub

Get to Know You Form

Family needs Assessment Intake Form

Thank you for submitting your form,
Please standby.

Your from has been successfully sent.
We will be in touch shortly, thank you

There were a few errors in your form.
Please follow the instructions on how to fix them and try again.

Thank you for submitting your form,
Please standby.

Your from has been successfully sent.
We will be in touch shortly, thank you

There were a few errors in your form.
Please follow the instructions on how to fix them and try again.

Get to Know You Form

Family needs Assessment Intake Form

Thank you for submitting your form, Please standby.

Your from has been successfully sent. We will be in touch shortly, thank you

There were a few errors in your form. Please follow the instructions on how to fix them and try again.

Thank you for submitting your form,
Please standby.

Your from has been successfully sent.
We will be in touch shortly, thank you

There were a few errors in your form.
Please follow the instructions on how to fix them and try again.