pci-database

Athlete Database

Salutation

First Name

First Name (required)

Last Name

Last (required)

Suffix

Family Name

Gender

Select your Gender

Father's Name

Mother's Name

Spouse Name

Address

Address required

Address 2

City

required

State

required

Pincode

required

Email

Phone Number

Cell Phone

Required

Birthday

dd/mm/yy

Education

Employment

Profession

Weight (Kgs)

Height (Cms)

Blood Group

Select Blood Group

Aadhar Card

Passport No.

PP Expiry Date

Passport Issued Place

Upload Passport

Resize & Upload 1 MB file size Passport Scan Copies Front & Back (JPG Format)

Impairment type ?

Physical Vision Intellectual Other

Applying for:

Involve in Sports Get Classified

Do you use a wheelchair?

Yes No

Passport Photo

resize your photo in jpg format within 500 KB file size

What is your medical diagnosis? *

To select more than 1 option hold Control Key + click on desired option, scrolling down

Describe your impairment & how it affects you

Please include list of (medical diagnosis should be mentioned as medical classification - category ) according to IPC medical classification guide or book

Which Parasport(s) are you interested in?

Select your Interested Parasport

Which sport/s have you previously been involved in?

Highest level of involvement in which sport ?

Classification in any sport/s ?

Sports Achievements & Awards

I acknowledge that by completing this form and expressing an interest in pursuing a particular sport, that the information I have provided, including my contact details are true to best of my knowledge and may be shared without nominated National or State Sporting organisations.