Starting on Monday, 13 July 2020 8:00 AM

The following fields are required.

Question Title

* 1. Account Owner First & Last Name

Question Title

* 2. Email

Question Title

* 3. First name

Question Title

* 4. Last name

Question Title

* 5. Mobile phone

Question Title

* 6. Emergency Contact Name

Question Title

* 7. Emergency Contact Phone Number

Question Title

* 8. Emergency Contact Relationship

The following fields are required

Throughout the 2020 Angel City Virtual Games presented by The Hartford, participants with a United States residence may be eligible to receive swag. Please ensure your mailing address is correct.

Question Title

* 9. Mailing Address Line 1

Question Title

* 10. Mailing Address Line 2

Question Title

* 11. City

Question Title

* 12. State: Please input state using capitalized U.S. Postal State abbreviations, i.e. CA, MO, etc.

Question Title

* 13. Postal Code

Question Title

* 14. Country

Question Title

* 15. T-Shirt Size: Please select one t-shirt size.

Question Title

* 16. Gender Identity: Please select one option.

Question Title

* 17. Date of Birth- MM / DD / YYYY Format

The disability information fields below are required.

Question Title

* 18. This section mirrors the Paralympic questionnaire structure for athlete information. Please select the physical disability that best describes you.

Question Title

* 19. Detailed Disability Information: This information is for our own demographic data in order to best serve our athletes. Please select all that apply.

Question Title

* 20. What is your mobility status? Select the option that applies to you.

Question Title

* 21. If you are comfortable, briefly share your story:

Please answer some personal information questions below.

Question Title

* 22. Are you a veteran? Select yes or no.

Question Title

* 23. Military Branch: select all that apply

Question Title

* 24. How many years did you serve? Please specify number.

Question Title

* 25. Race:

Question Title

* 26. Household Income

Question Title

* 27. Are you currently employed?

Question Title

* 28. Did your employment status change due to COVID-19?

Question Title

* 29. Are you a U.S. citizen? Select yes or no.

Question Title

* 30. Who are your favorite pro-athletes?

Question Title

* 31. Who are your favorite celebrities?

Question Title

* 32. What are your goals?

Question Title

* 33. Do you have any special talents?  Select yes or no.

Please answer some sport information questions below.

Question Title

* 34. Have you participated in Adaptive Sports before? Select yes or no.

Question Title

* 35. If you are not participating in as many adaptive sports as you would like, can you please share why? Select all that apply.

Question Title

* 36. If you selected access to equipment, what adaptive sports equipment do you need to participate in sport? Please type out answer.

Question Title

* 37. How did you hear about Angel City Sports? Select all that apply.

Question Title

* 38. Did you hear about Angel City Sports from any of the following partners? Please choose all that apply.

Question Title

* 39. Have you participated in Angel City Sports' Clinics (either in-person or virtual)? Select yes or no.

Question Title

* 40. Are you interested in learning more about career opportunities for people with physical disabilities? Select yes or no. If yes, you will receive emails from Ampla Partners.

Question Title

* 41. Are you interested in participating in the Virtual Ride on 8/9? Select yes or no.

Question Title

* 42. Do you currently have an account with any of the following virtual ride platforms?

Question Title

* 43. Do you have an Xbox Game Pass? Select one.

Question Title

* 44. Which of these games are you familiar with? Please select all that apply.

Additional Information

Question Title

* 45. Is there anything you would like the Angel City team to know in preperation for the 2020 Angel City Virtual Games presented by The Hartford? Please type out your comments.

Virtual Games Waiver of Liability

1. Waiver of Liability, Assumption of Risk, and Indemnity Agreement Waiver: In consideration of being permitted to participate in any way in the Angel City Sports Virtual Games presented by The Hartford on June 22, 2020 through August 29, 2020 hereinafter called the “Angel City Sports Virtual Games”, for myself, my heirs, personal representatives, or assigns, do hereby release, waive, discharge, and covenant not to sue Angel City Sports, their respective officers, board members, employees, agents, assigns, and successors in interest, including The Hartford Financial Services Group, Inc. and its affiliates, subsidiaries and parent companies, and all respective officers, directors, agents or employees, from liability from any and all claims including the negligence of or omissions by Angel City Sports, its officers, employees and agents, and/or The Hartford Financial Services Group, Inc., resulting in any injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in the Angel City Sports Virtual Games Assumption of Risks: Participation in the Angel City Sports Virtual Games carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks include, but are not limited to: (1) minor injuries such as scratches, bruises, and sprains; (2) major injuries such as eye injury or loss of sight, joint or back injuries, bone fractures, heart attacks, and concussions; and (3) catastrophic injuries including paralysis and death. I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in the Angel City Sports Virtual Games. I hereby declare that my participation is voluntary and that I knowingly assume all such risks. Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD HARMLESS Angel City Sports and/or The Hartford Financial Services Group, Inc. from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees, brought as a result of my involvement in the Angel City Sports Virtual Games and to reimburse them for any such expenses incurred. 2. Permission for Use of Name, Image and Statements I understand that in connection with Angel City Sports Virtual Games, there may be photography, audio, and video recording. By signing below, I grant absolute and irrevocable right and unrestricted permission to Angel City Sports and/or The Hartford Financial Services Group, Inc. to use my name, likeness, identity, voice, photographic image, videographic image and oral or recorded statements in any publication of the Angel City Sports Virtual Games to be used for research, educational, promotional, advertising, fundraising or other related use, including but not limited to, film broadcast, printed publications, webpages and web-based publications, news, web casts, telecasts, and social media associated or affiliated with Angel City Sports and/or The Hartford Financial Services Group, Inc.. By signing this form, I hereby waive and release Angel City Sports, and its officers, employees and agents, and/or The Hartford Financial Services Group, Inc., and each and all persons involved from any claim or liability relating to the use of my name, likeness, identity, voice, photographic image, videographic image and oral or recorded statements. I further waive all rights I may have to any claims for payments of money, compensation, or remuneration in any form and of any kind from Angel City Sports and/or The Hartford Financial Services Group, Inc., relating to the use of my name, likeness, identity, voice, photographic image, videographic image and oral or recorded statements, regardless of the purpose or sponsoring of such use by Angel City Sports and/or The Hartford Financial Services Group, Inc.. I also waiv

Question Title

* 46. Signature of Participant
BY SIGNING BELOW YOU ARE AGREEING TO ALL OF THE ABOVE STATEMENTS

If the Participant is a Minor, the Minor Participant’s Parent/Guardian must read this Waiver of Liability, Assumption of Risk, and Indemnity Agreement & PERMISSION FOR USE OF NAME, IMAGE AND STATEMENTS. Sign below.

Question Title

* 47. Parent/Guardian Signature

Question Title

* 48. Minor Participant's Name

T