CSCC Rider Information Form & Waiver

CSCC Rides, Information Form & Waiver 2022 joining us on rides and activities please submit the info below required once per year.
Upload a photo of yourself
You will receive a confirmation email with a QR code, save this code this will allow you to check-in easily and fast to CSCC casual rides without having to submit the form for each ride. This form is required once per year for all riders on CSCC casual rides thank you.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Email

Confirmation Emailexample@example.com
Gender
CLUB OR TEAM
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Blood Type, Use NA if you don't know
Allergies type NONE if not applicable
Comorbodities type NONE if not applicable
Could you please rate your cycling skills and knowledge?

1

2

3

4

5

1 is Beginner, 5 is Experienced
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Email
example@example.com
Are you willing to participate in a more detailed, anonymous survey?
QR Combination
Should be Empty:

CSCC Rides, Information Form & Waiver 2022 joining us on rides and activities please submit the info below required once per year.