After School Bike Club Flying Wheels 2015-2016 INFORMATIONAL PACKET Sept.-June* Wednesdays at 3:45pm 5:30pm * no riding Nov-Feb All skill levels welcome! Advanced riders group -speed, distance & endurance Social & New riders group -social riding and beginners Bikes can be stored in the Bike Shed Loaner bikes available (limited number) If you have questions contact Joan Goulding at jgoulding@spectrumcharter.org Completed forms must be turned into Ms. Joan or the front office Before or at your first ride First ride: Wed. Sept. 9, 2015
Flying Wheels After School Bike Club Cost of 65$ includes water bottle, weekly snacks, destination ride field trips, bike maintenance supplies and weekly attendance prizes. (payment options available) Club schedule: Sept 9: safety meeting, bike inspections, FIRST RIDE! Sept 16-May 25 weekly rides/destination field trips June: end of year field trip to Park City-Kimball Junction Weekly sessions begin from the Spectrum secondary building on Thursdays and include community streets and Legacy Parkway Trail rides Goal: To teach students effective and safe bicycling techniques, to ride with confidence on public roads, trails, and promote cycling for fun and good health. Student Requirements NO HELMENT NO RIDE Closed toed shoes/ water bottle Bike requirements: All bikes must have working brakes. Advanced riders will need gears, Social riders can ride BMX or cruiser bikes Topics and Skills Covered Getting to Know Your Bike/ Basic Bike Maintenance Fixing a flat, changing a tire, know the parts of the bike, bike inspection checklist Bike Driver s Ed /Commuting by Bike Learn and practice safe bike riding techniques and local bike laws. Night Riding, Bad Weather Riding Tips Learn the importance of lights & appropriate clothing Riding the Trails (with student interest) Practice your bike skills and pick up some tips for trail riding Bike Riding First Aid First aid for injuries or illnesses that could occur while cycling *Parent Volunteers are welcome* *your time will count towards your required school volunteer hours!* suggested volunteer options include additional weekly riders (does not require you to be there every week) securing donations (see Joan for needed supplies and gear) donating snacks, prizes or food for Club parties
Flying Wheels club shirts (please return this form) First shirt is free Return this t-shirt order form with registration forms Name Size OPTIONAL: additional shirts can be purchased for $12 each If purchasing extra shirts fees must be paid in full by Sept. 23th Number of extra shirts (circle) 1 2 3 4 5 Amount $ 3
MINOR RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT Emergency Information Flying Wheels Bike Club Program RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT ("AGREEMENT") IN CONSIDERATION of my child (provide name; hereafter referred to as the Minor Participant) being permitted to participate in any way in the Spectrum Academy After School Bike Club ( Flying Wheels ) sponsored Bicycling Activities ("Activity") I, for myself, my personal representatives, assigns, heirs, and next of kin: 1. ACKNOWLEDGE, agree, and represent that I understand the nature of Bicycling Activities and that the Minor Participant is qualified, in good health, and in proper physical condition to participate in such Activity. I further acknowledge that the Activity will be conducted over public roads and facilities open to the public during the Activity and upon which the hazards of traveling are to be expected. 2. FULLY UNDERSTAND that: (a) BICYCLING ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH ("RISKS"); (b) these Risks and dangers may be caused by the actions, or inactions, the actions or inactions of the Minor Participant or others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES incurred as a result of my child s participation in the Activity. 3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the Ride Coordinator, the Ride Assistants, the School District, other participants, any sponsors, advertisers, and, if applicable, owners and lessons of premises on which the Activity takes place, (each considered one of the "RELEASEES" herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, make a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim. 4
MINOR RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT (cont d) I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. Name of Minor Participant: Print Name of Parent/ Guardian: Signature of Parent/Guardian: Date: Address: City: Zip: Primary Phone # : Type: Home Work Cell Other Secondary Phone #: Type: Home Work Cell Other Email: Emergency Contact (in case you cannot be reached) Contact Name: Primary Phone #: Relationship to participant: " 5
SPORT / TEAM MEDICAL CLEARANCE FORM School Year: 2012/2013 Student Name Last: First: DOB: Phone: School: Anticipated Team/Club Activities Fall: Winter: Spring: A medical clearance shall be submitted (valid for one calendar year), signed by a medical doctor (nurse practitioners, chiropractors or other non-utah licensed medical doctors are not acceptable), stating that the Student has been physically examined and is deemed to be in sufficiently good health and fitness so that the Student may fully participate in Team Activities. For Physician s Use: I certify that I examined the above student and found him/her fit to compete in Team activities as follows: Past injuries and physical conditions that should be watched are: This Medical Clearance shall be valid for one year from the date signed below. Date Physician s Signature 6