Register for AceBuddies

Please feel free to email us at acebuddies@evansville.edu if you have any questions or concerns. If you need to reach us in the chance of an emergency, our program administrator is:

Dr. Kate Schwartzkopf, PT, DPT, PhD, OCS, CSCS

(she/her/hers)

Associate Professor/Physical Therapy and PhD in Health Professions Education

Room 3013, Stone Family Center for Health Sciences
812-488-2453
ks148@evansville.edu

Participant

Provide the following information for the person whom you are registering.

First name

Last name

Age

Date of birth

Grade

Language

Other language

Shirt size

Enter any specific sport or exercise the participant would like to learn in AceBuddies

Placement into either session 1 or session 2 is completely random, however do you have a preference in which session your participant is placed? Please note that this does not guarantee a placement in the option selected below.

Medical and Safety

Tell us about the participant's condition.

Participant's medical diagnosis

List any food allergies the participant may have.

Is there anything we should be aware of regarding students working with the participant in a high-stimulus environment?

Is there any other information we should be aware of to make this event safe and inclusive for everyone?

Mobility

Tell us about the participant's mobility.

How does the participant get around at home and/or on a playground?

Can the participant walk independently without assistance from another person?

Yes

Does the participant walk with the aid of a supportive device (crutches, walker, etc.)?

Yes

Does the participant require a wheelchair?

Yes, but does not require assistance to move.

Yes, and requires assistance to move.

Emergency Contact

In case of an emergency, who should we contact?

This person should be someone other than the parent or legal guardian who will accompany the participant.

First name

Last name

Relationship

Phone

Parent or Legal Guardian

Please fill in the following information for the parent or guardian that will be accompanying the participant.

This person should be someone other than the emergency contact.

First name

Last name

Phone

The AceBuddies Team will use the following email address for future communications.

How did you hear about AceBuddies?

University of Evansville

Academic Programs
Physical Therapy