2025 TCE Mujeres y Pedales Application

1
Team* This field is required.
Eagle/Edwards
Summit (Waitlist only)
Mesa
Routt
2
Are you interested in a scholarship?* This field is required.This program has a cost of $65 for the bike season, which includes at least 20 practices.
Yes 100% ($0 per practice)
Yes 90% ($0.40 per practice)
Yes 75% ($1.02 per practice)
Yes 50% ($2.34 per practice)
Yes 25% ($3.03 per practice)
No ($4.06 per practice)
3
Applicant Name* This field is required.
First Name
Last Name
4
Applicant's Phone NumberTCE communicate updates and information about practices and events through WhatsApp.
Please enter a valid phone number.
5
Email* This field is required.
example@example.com
6
Preferred language* This field is required.
English
Español
7
Medical History of applicant* This field is required.Mountain biking comes with some inherent risks, so we review relevant medical history to ensure this program is a safe and supportive fit for each participant. Please provide details for any ‘yes’ answers to help us better support their health needs and create a positive experience.
Yes
No
Allergies to foods
Row 0, Column 0
Row 0, Column 1
Allergies to bites/stings
Row 1, Column 0
Row 1, Column 1
Allergies to medications
Row 2, Column 0
Row 2, Column 1
Any other allergies (animals, grass, etc.)
Row 3, Column 0
Row 3, Column 1
Does the applicant carry an epi pen
Row 4, Column 0
Row 4, Column 1
Asthma or respiratory issues
Row 5, Column 0
Row 5, Column 1
Does the applicant carry an inhaler
Row 6, Column 0
Row 6, Column 1
Blindness/visual problems
Row 7, Column 0
Row 7, Column 1
Bone or joint problems
Row 8, Column 0
Row 8, Column 1
Chest pain
Row 9, Column 0
Row 9, Column 1
Concussion or serious head injury
Row 10, Column 0
Row 10, Column 1
Diabetes
Row 11, Column 0
Row 11, Column 1
Bleeds or bruises easily
Row 12, Column 0
Row 12, Column 1
Emotional/Mental/Behavioral issues
Row 13, Column 0
Row 13, Column 1
Hearing loss/hearing aid
Row 14, Column 0
Row 14, Column 1
Heart disease or defect, high blood pressure
Row 15, Column 0
Row 15, Column 1
Heat stroke/exhaustion
Row 16, Column 0
Row 16, Column 1
Major surgeries or serious injuries
Row 17, Column 0
Row 17, Column 1
Non-verbal
Row 18, Column 0
Row 18, Column 1
Seizures/epilepsy/fainting
Row 19, Column 0
Row 19, Column 1
Requires assistance
Row 20, Column 0
Row 20, Column 1
Uses wheelchair
Row 21, Column 0
Row 21, Column 1
Other
Row 22, Column 0
Row 22, Column 1
N/A
Row 23, Column 0
Row 23, Column 1
Allergies to foods
Allergies to bites/stings
Allergies to medications
Any other allergies (animals, grass, etc.)
Does the applicant carry an epi pen
Asthma or respiratory issues
Does the applicant carry an inhaler
Blindness/visual problems
Bone or joint problems
Chest pain
Concussion or serious head injury
Diabetes
Bleeds or bruises easily
Emotional/Mental/Behavioral issues
Hearing loss/hearing aid
Heart disease or defect, high blood pressure
Heat stroke/exhaustion
Major surgeries or serious injuries
Non-verbal
Seizures/epilepsy/fainting
Requires assistance
Uses wheelchair
Other
N/A
Yes
Row 0, Column 0
No
Row 0, Column 1
Yes
Row 1, Column 0
No
Row 1, Column 1
Yes
Row 2, Column 0
No
Row 2, Column 1
Yes
Row 3, Column 0
No
Row 3, Column 1
Yes
Row 4, Column 0
No
Row 4, Column 1
Yes
Row 5, Column 0
No
Row 5, Column 1
Yes
Row 6, Column 0
No
Row 6, Column 1
Yes
Row 7, Column 0
No
Row 7, Column 1
Yes
Row 8, Column 0
No
Row 8, Column 1
Yes
Row 9, Column 0
No
Row 9, Column 1
Yes
Row 10, Column 0
No
Row 10, Column 1
Yes
Row 11, Column 0
No
Row 11, Column 1
Yes
Row 12, Column 0
No
Row 12, Column 1
Yes
Row 13, Column 0
No
Row 13, Column 1
Yes
Row 14, Column 0
No
Row 14, Column 1
Yes
Row 15, Column 0
No
Row 15, Column 1
Yes
Row 16, Column 0
No
Row 16, Column 1
Yes
Row 17, Column 0
No
Row 17, Column 1
Yes
Row 18, Column 0
No
Row 18, Column 1
Yes
Row 19, Column 0
No
Row 19, Column 1
Yes
Row 20, Column 0
No
Row 20, Column 1
Yes
Row 21, Column 0
No
Row 21, Column 1
Yes
Row 22, Column 0
No
Row 22, Column 1
Yes
Row 23, Column 0
No
Row 23, Column 1
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8
Please describe any 'yes' options or if you selected 'other' about the applicant's medical history. Include any relevant medications.(optional)
9
Has the applicant been part of The Cycle Effect before?* This field is required.
YESNO
10
How many years has the applicant participated in The Cycle Effect?(optional)
Less than 1
1
2
3
4
5
6
7
8
11
Mountain biking experience* This field is required.How would you describe your current mountain biking experience level? Please select the option that best describes you. Beginner (1): I have little to no experience riding a mountain bike. I am new to trails and may need guidance on basic skills. Intermediate (2): I have some experience riding on trails and feel comfortable on beginner and intermediate terrain. I am working to improve my skills. Advanced (3): I have extensive experience riding on various terrains, including advanced trails. I feel confident and skilled as a mountain biker.
1
2
3
12
Please indicate any information that will benefit the applicant/coach training relationship (e.g. behavior management, communication, limitation, etc.).
Huge
Large
Normal
Small
Ok
Ok
13
Emergency Contact Name* This field is required.
First Name
Last Name
14
Emergency Contact Email* This field is required.
example@example.com
15
Emergency Contact Phone Number* This field is required.The Cycle Effect communicates information about practices and events through WhatsApp, a free messaging service.
Please enter a valid phone number.
16
Additional Emergency Contact: Name and Cell phone number(optional)
17
Town in which you reside(optional)
18
Which of the following best describes the applicant’s background? (Select all that apply)* This field is required.
White/Caucasian
Black/African American
Hispanic/Latino
Native Hawaiian or Pacific Islander
Native/Indigenous Peoples of the United States
Asian
Multi-Racial
Prefer not to answer
Other
19
If you selected other, please specify:(optional)
20
Which range best represents your household’s annual income?* This field is required.This information is kept confidential and helps us allocate resources equitably.
$0-$25,000
$25,001-$57,000
$57,001-$77,000
$77,001-$87,000
over $87,000
21
Typed SignatureThank you for submitting your application to join The Cycle Effect. We will review your application and be in touch with you soon. Please let us know if you have any questions at programs@thecycleeffect.org or 970-306-7572. Entering your email indicates agreement to receive communications from The Cycle Effect. Your privacy is important to us. We will not sell or rent your information to any third party companies or services.
First Name
Last Name
Should be Empty: