Krazy Kosci Klimb : Lead Participants EOI

Lead Participant EOI Registration

THANK YOU For applying to be a VILP (Very Important Lead Participant).

Spots for this event are limited and we often have more applications than we can accommodate. We will be in touch by September 2024 to let you know if your application has been successful or not.

Personal Details

Lead Participant Name *

Lead Participant Date of Birth *

Suburb *

State

Phone number *

Email *

What's the best way for us to contact you? *

How did you hear about The Krazy Kosci Klimb? *

What's your motivation to take on the challenge? *

Are you client of Cerebral Palsy Alliance? *

If so - what CPA centre do you attend?

Who is your CPA therapist?

What do you identify as your primary disability? *

Please provide more information about your primary disability *

Do you have any other disabilities or medical / health conditions? *

If yes, please specify your other disabilities or medical / health conditions:

Do you rely on a mobility aid?

If other, please specify

Have you done the climb before?

Yes
No

What distance of the climb do you expecting to walk if at all? (all-terrain wheelchairs will be provided for those who are not walking the full distan

18km - Walk the full distance of the summit without a wheelchair
9km - Walk half the distance of the summit without a wheelchair and complete the remaining distance with a wheelchair
5km - Walk 5km without a wheelchair and complete the remaining distance with a wheelchair
I don't expect to walk - I will use the wheelchair the whole distance

Which family members or friends would support you on your Krazy Kosci Klimb journey (* up to 3 people)?

Fundraising

Fundraising is a component of the Krazy Kosci Klimb. Funds raised support the accessible gym and sports program at Cerebral Palsy Alliance.

Please list some of your fundraising ideas you would use with your team. *

Do you feel you have a good understanding of what is involved in the Krazy Kosci Klimb? *

Yes
No, I would like some more information by email
No, I would like a phone call to learn more

Get Involved

Lead Participant EOI Registration

Personal Details

Fundraising

Made Possible By