Signature

Please sign below using your mouse.

Initial

Go Back

Move United Questionnaire (Adult)

RHI Sports is an honored recipient of the Hartford Adaptive Sports program grant, which is awarded in partnership with Move United.

Move United is asking these questions because they understand that there are inequities within the Disability community. To help Move United in their commitment to make sure that we are equitably supporting all, we ask that you complete the following questions, as the data collected will be used to better serve each person with a disability.

Please complete the questions you are comfortable answering. If you do not want to answer a question please just mark prefer not to say.

Thank you for your time.

Your Information

First Name *

Last Name *

Your Date of Birth

Email Address

May we add your address, phone and email to Move United data sheet*

Yes, add all

Only address

Only phone

Only email

Address and phone

Address and email

Phone and email

Do not give phone, email, or address to Move United

How many guests are attending with you?*

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?*

Gender*

Male

Female

Non Binary

Prefer not to say

Prefer not to self describe

LGTBQ+*

None

Yes

Prefer not to say

Race*

No, not if Hispanic, Latino, or Spanish origin

Yes, I am of Hispanic, Latino, or Spanish Origin

Prefer not to say

Hispanic, Latino, or Spanish Origin?*

No, not if Hispanic, Latino, or Spanish origin

Yes, I am of Hispanic, Latino, or Spanish Origin

Prefer not to say

Disability Type*

Cerebral Palsy

Mulitple Sclerosis

Nerve Damage

Post Polio

PTSD

Spina Bifida

Stroke

Traumatic Brain Injury

Joint Injury

Prefer not to say

I do not identify as having a disability

Disability Details*

Cerebral Palsy

Mulitple Sclerosis

Nerve Damage

Post Polio

PTSD

Spina Bifida

Stroke

Traumatic Brain Injury

Joint Injury

Prefer not to say

I do not identify as having a disability

Please enter participants' full names:

First Name *

Last Name *

Date of Birth

May we add your address, phone and email to Move United data sheet*
Yes, add all
Only address
Only phone
Only email
Address and phone
Address and email
Phone and email
Do not give phone, email, or address to Move United

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

Disability Details*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability
Other

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

First Name *

Last Name *

Date of Birth

How many guests are attending with you?

Is someone with you at our event a veteran?*
Yes
No

If yes, what rank and branch?

Gender*
Male
Female
Non Binary
Prefer not to say
Prefer not to self describe

LGTBQ+*
None
Yes
No
Prefer not to say

Race*
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Not listed

Hispanic, Latino, or Spanish Origin?*
No, not if Hispanic, Latino, or Spanish origin
Yes, I am of Hispanic, Latino, or Spanish Origin
Prefer not to say

Disability Type*
Cerebral Palsy
Mulitple Sclerosis
Nerve Damage
Post Polio
PTSD
Spina Bifida
Stroke
Traumatic Brain Injury
Joint Injury
Prefer not to say
I do not identify as having a disability

Add Another Name

Sign Here

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.