Request for Skating Accommodation Memorandum

Please provide the information below to be considered for a Skating Accomodation Memorandum. Only after receipt of this information will the U.S. Figure Skating Adaptive Skating Subcommittee National Vice Chair and necessary medical professionals have access to this material. You will be contacted if more information is needed. A Skating Accommodation Memorandum will be sent to you within 3 weeks of review.

Skater's First Name *

Skater's Last Name *

Skater's Member No. *

If Skater is Under 18, Legal Guardian's Name:

Street Address *

Address Line 2

City *

State *

Zip Code *

Preferred Phone Number *

Preferred Email Address *

Please attach pertinent medical information from your MD/PT/OT and IEP/504 documentation that is relevant for the U.S. Figure Skating Adaptive Skating Subcommittee National Vice Chair to review. *

Optional: here is an additional field if you need to upload additional documentation.

By signing below, Skater/Legal Guardian grants approval for the U.S. Figure Skating Adaptive Skating Subcommittee and assigned medical professionals to review these materials.

Skater/Legal Guardian Signature *

clear

Written Name *

Date * +