Bike4Change Membership

2022 Bike4Change

To apply for membership please complete all questions and sign below. 請填冩表格及簽名確認
Participant Information 參加者資料
Name 姓名 *

First Name Last Name
Mobile Phone 電話 *

Area Code Phone Number
Home Address 地址 *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email 電郵 *
Age 年齡 *
Do you regularly attend CEFC 經常參加CEFC嗎? *

Yes 是 No 不是
Emergency Contact 緊急聯繫人 *

First Name Last Name
Emergency Contact Phone 緊急手機號碼 *

Area Code Phone Number
Relationship 關係 *
I will join the program, please check one：請選擇，我會參加: *

Biker for fun 純享騎單車之樂 Volunteer leader/helper 單車領隊/同工幫手
I consider myself: please check one 我認為自己屬於：請選擇 *

Experienced cyclist 豐富經驗單車手 Like to join the 1st Saturday of the month bike ride. 希望參加每月第一個周六的單車活動 Beginner單車新手(Moderately Fit 狀態一般/Rusty 曰久生疏) Like to join the 2nd Saturday of the month bike ride. 希望參加每月第二個周六的單車活動 The coming year I will join the monthly bike ride and make a change 未來一年我會參加每月一次周六的單車活動並努力去改變
Liability Waiver Declaration 免責聲明
- I understand that CEFC Bike for Change is a voluntary participation program.
- I agree that my level of fitness is appropriate to participate in the event.
- I agree that my bicycle is in safe operating condition.
- I agree to not wear headphones or use a mobile phone while biking in the event.
- I agree to ride safely, signal my movements, be alert to my surroundings, stay to the right when riding slowly and pass on the left of other participants.
- I agree to obey the rules and directions of CEFC Bike4Change organizers and volunteers.
- I understand that bicycling involves risks and can result in loss of personal property, bodily injury or even death.
- I personally assume any and all of the risks associated with participation in this program and I release, absolve, indemnify and hold harmless the Chinese Evangelical Free Church, Monterey Park and all of their members, employees, directors, sponsors and volunteers from any manner of liability, claims for damages or causes of action.
- IF REGISTERING A MINOR(S), I affirm that I am the custodial parent or legal guardian of the minor. I consent to the above terms, including the waiver and release of claims on behalf of the minor(s).
- I affirm I have the authority to grant such consent, and I agree to supervise the minor(s) and ensure that the above terms are followed by the minor(s).
Liability Waiver *

I Agree 我同意
Media Release 媒體授權表格

I hereby assign and grant to Chinese Evangelical Free Church of Los Angeles, and assign the unqualified right of the ownership, use, and proceeds of all photographs or videos of me or my minor child, without reservation or limitation, including use of photographs or video of me or my minor child for, but not limited to, advertising, educational and promotional purposes.

我特此授權羅省華人播道會，並將我或我的未成年子女的所有照片或錄像的所有權,無條件的轉讓給羅省華人播道會，將我或我的未成年子女的所有照片或錄像，使用在廣告，教育和宣傳等等用途上。
Media Release *

I Agree 我同意 I Disagree 我不同意
Any special notes for our team 我們的團隊有什麼特別的注意事項嗎？
Participant's Signature 參加者簽名

By signing this document, I acknowledge that I have READ and UNDERSTOOD the above information and AGREE to the stated terms. I agree my electronic signature shall have the same force and effect as my written signature.

通過簽署本文件，我承認我已閱讀並理解上述信息並同意所述條款。我同意我的電子簽名與我的書面簽名具有同等效力。
Participant sign here *

Clear
Parent/Leal Guardian's Information 家長/監護人資料

Required if Participant is a minor
Parent/Guardian's Name 家長/監護人姓名

First Name Last Name
Mobile Phone 電話 *

Area Code Phone Number
Parent/Legal Guardian's signature 家長/監護人簽名

By signing this document, I acknowledge that I have READ and UNDERSTOOD the above information and AGREE to the stated terms. I agree my electronic signature shall have the same force and effect as my written signature.

通過簽署本文件，我承認我已閱讀並理解上述信息並同意所述條款。我同意我的電子簽名與我的書面簽名具有同等效力。
Parent sign here (if participant is a minor)

Clear
Should be Empty:

2022 Bike4Change

Participant Information 參加者資料

Parent/Leal Guardian's Information 家長/監護人資料