9.14 Bike Ride

Mountain Bike Ride Waiver Form

UAY SPARK will go on a mountain bike ride after school on Thursday, October 19 from 3:30-5:30pm. Please complete the form below to register your youth.
Is a school staff/SFA helping the family fill this form?*

YesNo
Contact Information

Please complete the information below
Participant's (Youth) Name*

First NameLast Name
Participant's (Youth) Date of Birth*

MonthDayYear
Date
Parent/Guardian Name*

First NameLast Name
Parent/ Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Email*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Has this youth participated in SPARK outdoor programming before?*

YesNo
Do you need to update any emergency contact or health/safety information?

Yes.No.
Did you already complete a "SPARK Health, Safety, & Liability Waiver" while registering for another Fall/Winter 2023 program?

Yes.No.

After you click "Submit" at the end of this registration, you will be redirected to the "SPARK Health, Safety, & Liability Waiver." This must be completed/updated for your teen to attend our outdoor programming.

Transportation Permission
United Action for Youth may transport my child to/from SPARK programming, including to/from home, school, or other spaces in the community per permission given from me, the parent/guardian.*

Yes.

Release of Liability and Assumption of Risk Agreement

Please read the following statements and select the acknowledgement statement
(1) I hereby understand that my child personally assumes all risks in connection with participation in United Action for Youth programming and hereby releases waives and forever discharges United Action for Youth and their employees, agents, volunteers and representatives (Releases) from any and all liability of any and every nature whatsoever, including claims or suits at law or in equity that I may have, for any and all personal injury. Including death, and property loss or damage that may result from, arise out of, or be related to my participation in the programming, including any travel to and/or from the program site. I hereby agrees to indemnify and hold harmless the Releasees from such liability whether injury, loss or damage is caused by my negligence, the negligence of the Releasees, or the negligence of any third party.
Please click button below to verify that you have read the statement above and you acknowledge the statement as the parent/legal guardian of the child named on this form.*

I have read and acknowledged the statement (1) above
(2) United Action for Youth may take photographs, videos and/or audio record my image and/or voice to use in promoting the purpose of the program. I understand that no financial benefits from the use of the photographs, videos and/or audio record are obligated to be paid to me.
Please click button below to verify that you have read the statement above and you acknowledge the statement as the parent/legal guardian of the child named on this form.*

I have read and acknowledged the statement (2) aboveI have read the statement and choose to decline having photo, video, and/or audio record, image and/or voice used by United Action for Youth.
I have read this emergency medical treatment consent form, release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement. I understand that a typed name in the box below functions as a legal signature.
Parent/guardian signature (please type name)*
As a school staff or student-family advocate, I certify that I have filled out this form in conjunction with a parent/guardian; that all the information provided is theirs; and was input with their permission. I understand that a typed name in the box below functions as a legal signature.
School staff signature (please type name)
Should be Empty:

Mountain Bike Ride Waiver Form

Contact Information

Transportation Permission

Release of Liability and Assumption of Risk Agreement