2025 TFKC Saturday Ride Program Online Participation Waiver and Release

Which program are you registering for?*

Is this your first time engaging with Trips for Kids Charlotte?*

YesNo

This form must be read, completed in full, signed and given to the Trips for Kids leader BEFORE the participant may join the activity. Express Assumption of Risk, Release, Indemnification and Covenant Not to Sue Agreement In consideration for the services of Trips for Kids, its activity leaders, officers, agents, and volunteers (collectively referred to herein as ‘Trips for Kids’) and its sponsors and affiliates, I, on behalf of myself and/or as the parent or guardian of the minor child participating in the Trips for Kids activity, and our heirs, agree as follows: I understand and am aware that bicycle trail riding, bicycle mechanics skills training, hiking, swimming, and related activities including, among others, use of Trips for Kids equipment such as bicycles, camp stoves, campfires, knives, tents and backpacks, bike shop tools and equipment (referred to herein as ‘Activity’), and transportation to and from such Activity, 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 Trips for Kids from any and all liability on account of, or in any way resulting from, personal injuries, death or property damage, other than as a result of Trips for Kids’ gross negligence, 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, other than as a result of Trips for Kids’s gross negligence. 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 Trips for Kids 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 Trips for Kids to call for medical or dental care for myself and/or my minor child if, in the opinion of Trips for Kids, 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.

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.

Yes No*

I hereby acknowledge that I have fully read, understood and accepted each of the above provisions, and voluntarily signed this agreement. Consent to Use Photographs To accomplish our goals, Trips for Kids frequently sends press releases and photographs to the media (ie. newspaper, TV, internet, 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 Trips for Kids to use any photos or videos taken of me during Trips for Kids activities.*

YesNo

Participant Name (please complete one form for every youth)*

First NameMiddle NameLast Name

Participants Birth Date*

MonthDayYear

Participants Gender Identity*

Student/Participants Email

example@example.com

Will the participant need to use a TFKC bike?

YesNo

If answering yes, please include the participant's approximate height, so we can provide a properly fitting bike for this event:

Participant Phone Number*

Is the participant currently taking any medications? (If yes please describe, if no type no.)*

Medications

Does the participant have any allergies that Trips for Kids staff/volunteers should be aware of? (If yes please describe, if no type no.)*

Allergies

Does the participant have any dietary restrictions that Trips for Kids staff/volunteers should be aware of? (If yes please list, if no type no.)*

Dietary (food) restrictions

Does the participant have any medical conditions that Trips for Kids staff/volunteers should be made aware of? (If yes please describe, if no type no.)*

Medical Conditions

Parent/Guardian Full Name*

First NameMiddle NameLast Name

Emergency Contact Number*

Please enter a valid phone number.

Participant Name*

Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian E-mail*

example@example.com

Parent/Guardian Mobile Number*

Parent/Guardian Full Name *

First NameLast Name

Parent/Guardian Work Number*

Date*

Date

Parent/Guardian Signature*

I hereby agree to assume the risk for any injury or damage to person or property I or others may sustain while using and operating this bicycle, and release Trips for Kids (National) and its affiliates, officers, directors, and employees, agents and volunteers from claims of any kind arising from use of this bicycle. I have read and acknowledge and release and agree to the terms.

Signature of Parent/Guardian*

Date

Name of Parent/Guardian*

First NameLast Name

Additional Comments

2025 Trips for Kids Charlotte Ride Program Activity Registration Form