Information and Waiver

Please remember to answer questions based on the participant's information, not the parent information unless indicated.
The following fields are required.

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* 1. Participant First Name

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* 2. Participant Last Name

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* 3. Parent/Guardian First Name

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* 4. Parent/Guardian Last Name

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* 5. Date of Birth (MM/DD/YYYY)

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* 6. E-mail

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* 7. Mobile phone

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* 8. Most recent grade completed in Spring of 2021

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* 9. Emergency Contact Name

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* 10. Emergency Contact Phone Number

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* 11. Emergency Contact Relationship

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* 12. Mailing Address Line 1

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* 13. Mailing Address Line 2

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* 14. City

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

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* 16. Postal Code

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* 17. Country

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* 18. Gender Identity: Please select one option.

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* 19. Race:

The disability information fields below are required.

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

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

Additional Information

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

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* 23. Annual Household Income (Completely confidential)

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* 24. Have you participated or volunteered in any adaptive sports before? Select yes or no.

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* 25. Other than family or friends, have you ever talked to, participated with, or worked with a person with a physical disability?

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* 26. On a scale of 1-10, 1 being Poor and 10 being Exceptional, how would you rate your knowledge about physical disabilities in general?

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* 27. On a scale of 1-10, 1 being Poor and 10 being Exceptional, how would you rate your knowledge about how to interact/work with people with disabilities?

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* 28. On a scale of 1-10, 1 being Poor and 10 being Exceptional, how would you rate your knowledge about the upcoming 2020 Tokyo Paralympic Games?

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* 29. On a scale of 1-10, 1 being Poor and 10 being Exceptional, how would you rate your interest level in the upcoming 2020 Tokyo Paralympic Games?

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

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* 31. Is there anything you would like the Angel City team to know in preparation for the Youth Leadership Council? Please type out your comments.

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* 32. Youth Leadership Council Information Letter Acknowledgement

Angel City Sports Summer Series Waiver
Event Date: June 29th – August 7th
 
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 Summer Series on, hereinafter called the “Angel City Sports Summer Series”, for myself, my heirs, personal representatives, or assigns, do hereby release, waive, discharge, and covenant not to sueAngel City Sports, their respective officers, board members, employees, agents, assigns, and successors in interest, from liability from any and all claims including the negligence of or omissions by Angel City Sports, its officers, employees and agents, resulting in any injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in the Angel City Sports Summer Series.
 
Assumption of Risks: Participation in the Angel City Sports Summer Series 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 Summer Series. 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 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 Summer Series 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 Summer Series, there may be photography, audio, and video recording.  By signing below, I grant absolute and irrevocable right and unrestricted permission to Angel City Sports to use my name, likeness, identity, voice, photographic image, videographic image and oral or recorded statements in any publication of the Angel City Sports Summer Series 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.
 
By signing this form, I hereby waive and release Angel City Sports, and its officers, employees and agents, 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 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.  I also waive any right to inspect or approve any photo, video, or audio recording taken or used by Angel City Sports.
 
I acknowledge that Angel City Sports will rely on this permission and release in producing, broadcasting, and distributing materials containing my name, likeness, identity, voice, photographic image, videographic image or oral or recorded statements.
Governing Law and Jurisdiction: This agreement shall be governed by the laws of the State of California, and any disputes arising out of or in connection with this Agreement shall be under the exclusive jurisdiction of the Courts of the State of California.
 
Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the laws of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
 
Acknowledgment of Understanding: I have read both (1) the Waiver of Liability, Assumption of Risk, and Indemnity Agreement; and (2) Permission for Use of my Name, Image, and Statements, and fully understand the terms. I understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.
 
I am an adult, 18 years or older, and I have read and understand this Agreement and freely and knowingly give my consent to Angel City Sports as described herein.
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.

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* 33. Parent/Guardian Signature
BY SIGNING BELOW YOU ARE AGREEING TO ALL OF THE ABOVE STATEMENTS

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* 34. Minor Participant's Name

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