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Fundraising Page Information
Campaign Title
*
Page Link
*
Text entered in this field will be used as the final portion of your page's URL.
Custom page link requirements: only letters, numbers, dashes, or underscores.
Your page link:
https://give.challengedathletes.org/campaign
/
Campaign Date
*
Show a date for your campaign on your fundraising page.
Fundraising Goal
*
$
Registration Questions
Date of Birth
*
(ex: mm/dd/yyyy)
Gender
*
[Select...]
Male
Female
Non-binary or Non-conforming
Prefer not to indicate
Emergency Contact Name
*
Emergency Contact Phone
*
(ex: 123-123-1234)
Are you a Challenged Athlete? Challenged Athlete = A person with a permanent physical disability pursuing an active lifestyle through physical fitness or competitive athletics
*
Yes
No
What is your primary diagnosis?
*
[Select...]
Achondroplasia or dwarfism
Albinism
Amniotic Band Syndrome
Amputations, acquired or congenital limb deficiencies
Aniridia
Arthrogryposis
Ataxia
Blind from Trauma
Brachial Plexus Injury
Caudal Regression
Cerebral Palsy
Cerebrovascular Accident (Stroke) – (must permanently impair muscle power or mobility)
Charcot-Marie-Tooth
Chorioretinal degeneration
Cone Rod Dystrophy
Ehlers-Danlos Syndrome – (must permanently impair mobility)
Erb’s Palsy
Friedreich Ataxia
Glaucoma
Hemiparesis (R or L sided)
Hemiplegia (R or L sided)
Hypotonia (must permanently impair mobility)
Leber’s Optic Neuropathy
Macular Degeneration
Multiple Sclerosis
Muscular Dystrophy
Myopathy (must permanently impair muscle power or mobility)
Neuropathy (must permanently impair muscle power or mobility)
Optic Nerve Hypoplasia
Osteogenesis Imperfecta (must permanently impair mobility)
Paraplegia
Polio
Quadriplegia
Retinal detachment/Retinoblastoma
Retinitis Pigmentosa
Sacral Agenesis
Spina Bifida
Spinal Cord Injury (acquired after birth)
Spinal Muscular Atrophy (SMA)
Transverse Myelitis
Traumatic Brain Injury (must permanently impair mobility)
Visual impairment (total or partial)
Other
Please select level of amputation:
*
[Select...]
Amputee, Single Below Knee
Amputee, Single Above Knee
Amputee, Bilateral Below Knee
Amputee, Bilateral Above Knee
Amputee, Single Below Elbow
Amputee, Single Above Elbow
Amputee, Bilateral Below Elbow
Amputee, Bilateral Above Elbow
Amputee, single lower limb and single upper limb
Amputee, Quad
Amputee, Trilateral
Hip Disarticulation
T-Shirt Size (Gender):
*
[Select...]
Women XS
Women S
Women M
Women L
Women XL
Men S
Men M
Men L
Men XL
Men 2XL
Men 3XL
How would you describe your personal connection to Challenged Athletes Foundation?
*
I am a challenged athlete
I know someone who is a challenged athlete
I am passionate about the CAF mission
I prefer not to say
What kind of fundraiser will this be?
*
[Select...]
Athletic individual (walking, cycling, swimming, tri, etc.)
Athletic group (basketball, relay, race, etc.)
Celebration (birthday, wedding, bar/bat Mitzvah, etc.)
Event (game night, movie night, food/beverage party, etc.)
In Honor of or In Memoriam
No special reason, I just want to fundraise for CAF
Other
Please describe:
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