Mountain Bike Mondays Ride Registration Form

Page 1

Thanks for your interest in Trips for Kids Marin. Please fill out this Registration Form. 

In order to participate in a Trips for Kids Marin ride program, your child must meet a few minimum requirements listed below. By continuing with their registration you are acknowledging that they meet these criteria:
  1. Between 10 and 15 years of age.
  2. Have basic riding proficiency (use balance to stay upright and use hand brakes to control speed and stop.)
  3. At least 4’6” in height (if they are using a Trips for Kids Marin bicycle.)
  4. Their personal bicycle is in good mechanical condition if they are using their own.
  5. Are well behaved and will follow the instruction of Trips for Kids Marin staff.
  6. Have no medical issues that would prevent them from participating in a day-long, athletic outdoor experience. 
Your ride is NOT CONFIRMED until you hear from a Ride Coordinator in response to your request below. If you have any questions, please contact Adam Smith at 415-458-2986 x5 or adam@tripsforkidsmarin.org.
Youth Participant Information





The following information may be used for more than one outing. You must inform the activity leader if any of this information changes from outing to outing.



Parent/Guardian Information










Ride Date Request(s)
You may request one or more ride dates. To request more than one, click Add Another Ride below. 


Page 2

Trips for Kids Marin Activity Permission Form 

This form must be read, completed in full, signed and given to the Trips for Kids Marin Leader BEFORE the participant may join the activity or ride in a TFKM vehicle.

Express Assumption of Risk, Release, Indemnification and Covenant Not to Sue Agreement

In consideration for the services of Trips for Kids Marin, its activity leaders, officers, agents, and volunteers (collectively referred to herein as ‘TFKM’), I, on behalf of myself and/or as the parent or guardian of the minor child participating in the TFKM activity, and our heirs, agree as follows:

I understand and am aware that bicycle riding/mountain biking, bicycle mechanics skills training, hiking, and related activities including, among others, use of TFKM equipment such as bicycles, helmets, gloves, water bottles, camp stoves, campfires, knives, tents and backpacks, bike shop tools and equipment (referred to herein as ‘Activity’), and transportation to and from such Activity in a TFKM vehicle, are Hazardous Activities involving Inherent and Other Risks of injury to any and all parts of the body. I further understand that injuries in the Activity are a Common and Ordinary Occurrence, and I have made a voluntary choice for myself and/or the minor child listed below to Accept and Assume All Risks of Injury or Death that might be associated with or result from this Activity.

To the fullest extent allowed by law, I agree to Release from Liability, and to Indemnify and Hold Harmless TFKM from any and all liability on account of, or in any way resulting from, personal injuries, death or property damage, in any way connected with this Activity. I further Agree Not to Make a Claim or Sue for Injuries or Damages Relating to This Activity. I understand and agree that this Agreement is intended to be as broad and inclusive as is permitted by law, and if any portion is held invalid, the balance shall continue in full legal force and effect. I agree that no oral representations, statements or inducements apart from this Agreement have been made.

Authorization for First Aid and Medical Treatment

I recognize that medical or dental care may be necessary for myself and/or my minor child. I Authorize TFKM and the Activity Leader(s) to Render First Aid or Emergency Care, within the scope of the certification of the activity leader(s). In addition, I authorize TFKM to call for medical or dental care for myself and/or my minor child if, in the opinion of TFKM, medical or dental care is needed. I Agree to Pay for All Expenses and Costs Associated With Such Care and Related Transportation. In addition, I hereby authorize and consent for any x-ray examination, anesthetic, medical, dental or surgical diagnosis rendered under the general or special supervision of any member of the medical staff and/or emergency staff and/or dentist currently licensed by the state in which treatment is given and the staff of any acute general hospital holding a current license to operate a hospital from the State of California Department of Public Health or the equivalent agency in another state. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required but is given to provide authority and power to render care which the physician in the exercise of his best judgment may deem advisable. It is understood, medical condition allowing, that effort shall be made to consult the undersigned prior to rendering the treatment to the patient, but that any of the above treatment will not be withheld if the undersigned is incapacitated or cannot be reached.
  
Consent to Use Photographs 

To accomplish our goals, TFKM frequently sends press releases and photographs to the media (i.e. newspaper, TV, internet, social media, etc.) and uses photos in our own publications. It is the right of the individual whether or not to consent to the use of his/her photograph and/or name for the above publicity purposes. I hereby authorize TFKM to use any photos or videos taken of me during TFKM activities. 

 
By clicking Submit below, I
 hereby acknowledge that all the information I have provided on page 1 and page 2 of this agreement is true, correct and complete. I agree to update page 2 of this agreement as necessary. I hereby acknowledge that I have fully read, understood and accepted each of the above provisions, and voluntarily signed this agreement.

When finished, click Submit below. You will be taken to the Trips for Kids Ride Payment page. Please make payment to complete your ride registration(s).