Live to Ride Application Package

Application Form

*Youth must be at least 12 years old by start of program to apply.

*See our Privacy Policy for details on how we manage your information. We never share or sell your information.

Full name of applicant*

First NameLast Name

Age (as of July 1 year of program applying for)*

Applicant's Pronouns (select those that apply):*

How did you hear about us?*

Place of Residence*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you identify as an individual within the BIPOC community? - All information will be kept confidential in accordance with federal law and does not affect your eligibility for our programs, we collect this information to provide participant demographics to our funders.*

YesNoPrefer not to answer

If you answered 'yes' to the previous question, please select from list below:

Are you a first time mountain biker?*

If you responded 'No' to the previous question, please tell us how many days' experience you have and how long ago.

Will this be your first time participating in our 'Live to Ride' program or are you applying for 'Ride More' ('Ride More' is for your who have already completed our 'Live to Ride' program and priority for 'Ride More' is given to older youth and youth with positive attitude and attendance during Live to Ride). *

Do you own a bike with single or dual suspension? (Not required, but we would like to know if you are using your own bike for some of the trips and inspect it before the program starts)*

In your own words please explain why you would like to participate in our 'Live to Ride' program.*

Are you available on Tuesday and Thursday evenings in July and August? *Note: two of the dates will be full days at Big White, instead of evenings. Big White dates will be determined once all program applicants are chosen.*

Please list any known conflicts with these dates:*

RENTAL INFORMATION: Please enter youth's height, weight, shirt and shoe size (for bike sizing purposes):*

Parent/Guardian Email Address (this is where we will send notice of acceptance into the program and program information once accepted)*

example@example.com

PICK UP LOCATION: Are you able to meet at one of our central pick-up locations - West Kelowna Xtreme Theatre parking lot (beside Dairy Queen), Orchard Park Mall (beside bus loop), Rutland Shell (Hwy 33 and Gerstmar), or Rutland 7-11 (Hwy 33 and Rutland Rd) for transport to the mountain?*

TYPE OF SPOT: Please indicate the type of seat you are applying for:*

Paid ($500/participant - invoice will be sent once participant has been accepted into the program)Scholarship (Free for eligible youth - please select from eligibility criteria below)Partial (if you do not meet any of our eligibility requirement for a full scholarship (listed below) but would like to inquire about partial support, please select this option and we will follow up with you to discuss options)

Please see eligibilty criteria below

If selecting eligibility criteria that requires documentation/proof of eligibility, please email 1 document to confirm eligibility to Programs@elevationoutdoors.ca (if you've selected multiple criteria that apply, you do not need to send documention for every one, choose the one that is easiest to provide).

To see the current Low Income Cut-Offs (LICO), click here and scroll down to 'Who We Serve'.

If you selected "Scholarship" for TYPE OF SPOT above, please select all that apply.

Parent/guardian or the youth are receiving social assistance *Proof of assistance requiredThe youth is involved with MCFD programs or is in foster care *Letter from social worker requiredThe youth is on parole, probation, or in a restorative justice program *Letter from office/case worker requiredThe youth is connected to a mental health clinician or practitioner *Letter from mental health worker required*The youth identifies as Indigenous (or Metis, First Nations, etc. - no proof necessary)Parent/Guardian living with the participant has income at or below the Low Income Cut-Offs *Proof of income requiredI do not meet any of these criteria, but still face financial barriers. I would like to be contacted about a Partial Scholarship.

GOOGLE CALENDAR SHARING AND JUMPSTART PERMISSION:

Elevation Outdoors has permission to share Google Cal dates with my and/or my child's email adress (leave blank below if not interested).

Parent/Guardian Email Address

example@example.com

Youth Email Address

example@example.com

I give permission to Elevation Outdoors to contact me about future programs and opportunities that come available.*

I give permission for Elevation Outdoors to provide my contact information to the Canadian Tire Jumpstart Foundation. As partial funders for this program they like to be able to contact you directly with future opportunities.*

Dear parent or legal guardian, Elevation Outdoors is running a program called ‘Live to Ride’ over the summer for youth in the local area. The program involves teaching young people to mountain bike starting from the elementary level. It will be using various terrain within the Okanagan valley, including cross country and downhill mountain biking. The program also involves reflecting upon these experiences and using it as a metaphor for life experiences and learning. It will run for 7 weeks during summer, on Tuesday and Thursday afternoons with two full-day trips to Big White, for downhill riding. This letter is to inform you of the program and the expressed interest, and also of the inherent risks in the activity of mountain biking. On my behalf, and on the behalf of any minor children participating in these activities, for whom I am legally responsible, I agree to the following: ASSUMPTION OF RISKS: I am aware and understand that MOUNTAIN BIKING activities involve many risks, dangers and hazards, including but not limited to the following: I acknowledge and accept that mountain biking involves risks, dangers and hazards in addition to those normally associated with bicycle riding and that injuries are a common and expected part of mountain biking. The Live to Ride program may take place on steep and rugged terrain and will expose the rider to many risks, dangers and hazards. The terrain may be un‐inspected, uncontrolled and unsafe due to constantly changing conditions. The inherent risks, hazards and dangers include but are not limited to the following: collision with other riders, vehicles, bicycles, trees, tree stumps, tree wells or other objects; fences and other man made structures; mechanical failure of equipment; rapid and uncontrolled acceleration on hills and inclines; changing weather conditions; unsafe terrain including steep or slippery sections, cliffs, rocks, holes, or crevices; extreme variation in cycling terrain; encounters with domestic and non domestic animals; falling or being thrown off the mountain bike; negligence on the part of Elevation Outdoors – including the failure to protect the participant from the risk, dangers and hazards of mountain biking or to predict the whether the terrain is safe for mountain biking; negligence of other riders. I understand and acknowledge that no amount of caution, experience and instruction can eliminate all of the risks involved and I freely assume all such risks, dangers and hazards and the possibility of personal injury, death, property damage and damages or loss resulting therefrom.I understand and acknowledge that no amount of caution, experience and instruction can eliminate all of the risks involved and I freely assume all such risks, dangers and hazards and the possibility of personal injury, death, property damage and damages or loss resulting therefrom.Elevation is requesting that you fill out the form below stating that you have read and are aware of the inherent risks of this activity, before your child is permitted to participate in the program. We are also requesting that you fill out the attached medical form with all relevant details and BC medical numbers.Please be assured that all appropriate safety measures and risk management practices will be exercised while the program is being delivered. Helmets are mandatory. Body armour will also be worn on the downhill days. Participants will be supervised during all bike trips, and ‘black’ or most difficult runs will not be utilized unless appropriate skill has been demonstrated beforehand. It is our intention to create a lasting, learning experience for the young people involved and we will be taking their safety very seriously.*

I have read the above statement and accept the risks involved for my child.

Parent/Guardians Full Name*

First NameLast Name

Participants Full Name*

First NameLast Name

Please Read and Sign - Parent/Guardians Signature*

I have read the above letter and understand the inherent risks in the activity of snowboarding, as well as the risks of participating in the program. I give my child permission to participate with this in mind.

Please Read and Sign - Participants Signature*

I have read the above letter and understand the inherent risks in the activity of mountain biking, as well as the risks of participating in the program. I still want to participate with this in mind.

PHOTO AND VIDEO RELEASE - Parent/Guardian Signature

Elevation Outdoors has permission to use my or my child’s photograph/video/audio recordings to promote the organization. I understand that the images may be used in various formats not limited to print publications, online publications, presentations, websites,and social media.

CONTACTING YOUTH: Elevation Outdoors has permission to contact my child by phone (text or call) to confirm program attendance and to communicate with as need arises, during or between program dates. If you do not want this - leave this section blank.

Area CodePhone Number

Do you give permission for your youth to be registered as a member of MTBCo, our local mountain bike advocacy group?*

YesNo

Input Todays Date*

Date

Participants Name*

First NameLast Name

Participants Date of Birth*

Date

Participants BC Care Card Number*

Please provide the correct care card number

Parent/Guardians Name*

First NameLast Name

Parent/Guardians Phone number - Provide preferred contact number*

Area CodePhone Number

Parent/Guardians Alternate Phone number - provide a second number to be reached at (Work, Home, Cell)

Area CodePhone Number

Emergency Contact - Provide who we should call in case we cannot reach you in case of emergencies.*

First NameLast Name

Emergency Contact Phone Number - Please provide the number of the person listed above.*

Area CodePhone Number

Has you child ever suffered from Asthma?*

If Yes, please provide if they have medication and what it is/usage.

Does your child suffer from any allergies?*

If yes please list what they are and any medications they take, if it is anaphylactic and if they have an EpiPen.

Does your child suffer from any of the following?*

Please select any/all that apply. Hold Cntrl or Command to select multiple entries.

Does your child suffer from any of the following?*

If you selected any of the above options, please provide more information about them below.

Please let us know what the issue is/was, any medications they are on, and best practices for managing it.

When was the participants last Tetanus shot?*

Answer as accurately as possible. If not within the last 10 years, participant may receive a tetanus injection by a medical officer if they receive a tetanus prone wound.

Is your child on any ongoing medications?*

Please provide details of medications, dosage, and frequency taken.

If you answered yes to the above question, do you give permission to your child to self administer these medications?

If no please explain.

Please select any of the following non-prescription medications you give permission for your child to receive if needed.*

Hold Cntrl or Command to select multiple options.

Please select any of the following non-prescription medications you give permission for your child to receive if needed.*

Advil/Tylenol - pain/feverCold/Flu TabletsAntihistamine - bites/stings/allergiesNone

Is there anything about your child's situation that we need to be aware of in regards to his/her participation in this program? Is there anything that may impact others in the program we need to be aware of?*

Example - Behavioural, Dietary, or Medical concerns

In the case of accident or illness, I authorize the caregiver to administer first aid and/or be taken to the nearest emergency centre. I consent for my child to receive medical treatment. I consent that in the event of severe injury or illness the means of transportation may be ambulance at a cost to myself.*

Parent/Guardian Signature*

I declare that the information which I have provided on this form is complete and correct and that I will notify the program if any changes occur. I authorize the facilitator who is with my child to consent, where it is impractical to communicate with me, for my child to receive such medical or surgical treatment as may be deemed necessary.

Date of Submission*

Date

This program is brought to you, in part, by:

Live to Ride Application Package

Live to Ride Permission Form

Participants Medical Form

Medical History