Register for Bike Week, June 17 - 21, 2019

Si necesita ayuda para registrarse en español, comuníquese con Maria Rangel al (503) 262-4029.

BEFORE YOU BEGIN, HAVE THESE THINGS READY:

  • Allow 20-30 minutes to complete the form.
    We recommend that you do NOT register on your phone--there are a lot of questions and many of them require lengthy/thorough answers.
     
  • Credit card.
    Payment is required upon completion of this registration form (unless Bike Camp is full and you are signing up for the waiting list). If you wish to contact us about scholarships or other funding sources, please contact annbikefirst@gmail.com BEFORE beginning registration.
     
    • Cost of a full week of Bike Camp for first-time campers is $250
    • Cost of a full week of Bike Camp for returning campers is $200
    • Cost of 3-day Quick Start / Refresher Course is $150
  • Full-face photo of the rider in jpeg format.
    You will be uploading it at the end of this form and will not be able to complete registration without it.
     
  • Make sure you are available to attend the MANDATORY parent/caregiver meeting on Sunday, June 16th at Concordia University Gym at 6:00 pm.
     
  • Rider's weight, height, and inseam measurements.
    Very important! Accurate measurements provide essential information for bike size selection.

After payment is processed and ALL required pieces are complete, we will confirm the rider's session via e-mail. Please check your spam/junk folder, as this has been a problem in the past.

To measure inseam accurately, you will need a tape measure and a large clipboard or large, thin book.

  1. Remove rider’s shoes and back him/her up against a wall.
  2. Place the book or clipboard between the rider’s legs with the edge square against the wall so that it acts as a T-square.
  3. Raise the book ALL the way while maintaining the T-square effect. Make sure rider’s heels remain on the floor. The measurement needs to be from the pubic bone to the floor.
  4. Measure the distance from the top of the clipboard/book to the floor.

Bike Week Registration
Registration is for...
Preferred Bike Clinic Sessions
Indicate Your First Choice
Indicate Your Second Choice
Your Information
Rider Information
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Rider T-Shirt Size
T-Shirt Size
Youth or Adult?
Rider Measurements
Rider's Medical Information
Include information about dietary restrictions and allergies (food related, bee stings) as well as specific instructions related to seizure disorders. This information helps ensure that staff and volunteers are matched appropriately with your child and adequately prepared in the event of an emergency. If not applicable, enter "N/A"
About the Rider: Please be specific and detailed
Bring any of these items to clinic as a motivator.
Riding History
Attach a photo of the Rider
Please submit a FULL FACE photo of the applicant
No file selected
Waiver / Release
Photographic Release
I/We hereby give consent to Northwest Disability Support and to photograph the participant to educate others about the programs and services offered by Northwest Disability Support. Among the uses contemplated are illustration of articles in newsletters, in profiles that contributors receive, in brochures, to illustrate services discussed on the web site, in displays at community fairs, to publicize local programs, to make professional presentations, to conduct research on teaching techniques and equipment used at the clinic, and to publicize the equipment and teaching methods used. In giving approval, I/we understand it is without consideration of compensation of any kind, and Northwest Disability Support released from any claims or liability.
Medical Release
In the event that an emergency requiring medical or surgical care or treatment should arise while the participant is attending the Bike First! program, and I/We ARE NOT PRESENT TO MAKE MEDICAL DECISIONS, I/we give consent for Bike First! clinic staff to select and designate nurses, physicians, emergency medical staff (EMS) and surgeons to furnish such medical and/or surgical care as, in the judgment of a physician and/or surgeon holding a physician’s certificate issued by the Board of Medical Examiners of the State of Oregon may be needful and proper. I/We absolve Northwest Disability Support, Bike First!, nurses, physicians, EMS personnel, and surgeons selected and designated by them, from any and all liability for their acts rendered in good faith.
Personal Property
I/We recognize that Northwest Disability Support/Bike First! cannot accept responsibility for participant’s personal property. To help eliminate losses, please tag name inside equipment, clothes or other personal items.

Electronic Signature
Signature
By checking the "I Accept" box, you are signing this Registration Form electronically ("E-Signature"). You agree your E-Signature is the legal equivalent of your manual signature on this Registration Form, as if actually signed by you in writing.

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