Summer Bike Camp Registration

CONFIRM THE DATE BY CHECKING THE BOX BELOW

• Week One: June 10 - 17, 2024

• Week Two: June 17 - 21, 2024

Campers must be between the ages of 6 and 16 at the time bike camp begins.
Any exceptions must be approved by Bay Area BMXers prior to registering.

CAMPER DETAILS


California
PARENT / GUARDIAN INFORMATION



Camper Birth Date:

CAMPER INFO AND SPECIAL REQUESTS
Has the above address and/or phone number changed in the last year?
YesNo

Is there another camper with whom your child would like to be in a group with?
(Please indicate friend's full name. We will try to accomodate requests but cannot guarantee)

Are there any activities in which camper should not participate?

Does camper have any special physical, behavioral and/or needs our staff should be aware of?

Are there any custody details we should be made aware of?

HEALTH HISTORY
Does your camper have any allergies or health issues we should be aware of?

EMERGENCY CONTACT / CHILD RELEASE AUTHORIZATION
"The Bay Area BMXer Camper has my unrestricted permission to relaease the named minor at any time to the following individuals, and/or to contact them in case of emergency if the primary parent or guardians are unavailable"

PARTICIPATION AGREEMENT
Please go over these items with your child:

1. Participant agrees to abide by rules and regulations set by the program for the health, safety and welfare of the participants.

2. All medications will be brought directly to the site staff in accordance with the Medications Policy.

3. Willful destruction of property will be the responsibility of the participant's parent or guardian.

4. Participants must remain within the established boundaries wherever the program occurs on and off BAY AREA BMXers property.

5. Participants are not allowed to be in possession of any tobacco, alcohol, illegal drugs, firecrackers, firearms or knives.

6. BAY AREA BMXers is not responsible for lost, damaged or stolen personal belongings.

7. Continued inappropriate behavior, such as threatening, swearing, not following directions, teasing, sexual harassment or intimidation, fights, or improper behavior in vehicles, may result in immediate dismissal from the program with no refund.

8. Any participant who poses a threat to themselves, or to others, will be dismissed from the program with no refund.

The Program Director reserves the right to determine what constitutes a violation of these rules and will enforce them as necessary.

We reserve the right to dismiss any participant from the program, at the Parent or Guardian's expense and liability, for violating any of the above rules.

- I have read and understand the Participation Agreement above:
Yes

PARENTAL AND/OR GUARDIAN CONSENT
Recognizing that the BAY AREA BMXers will do its best to ensure a safe experience, I understand that certain dangers or accidents may occur. I hereby release the BAY AREA BMXers of the Central Bay Area from any and all responsibility and liability of any nature, including claims of injury, illness, death, loss or damage, resulting from my child's participation in any program activities.

- I have read and understand the Parent/Guardian consent terms above:
Yes

MEDICAL CONSENT
As the parent, legal guardian, or authorized representative, I hereby give consent to the BAY AREA BMXers Summer Camp to provide all emergency dental or medical care prescribed by a duly licensed physician (MD or DO) or dentist (DDS) for the above named child. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of the child.

- I have read and understand the Medical Consent terms above:
Yes
Please provide the name of health insurance provider (if applicable):

DISCLAIMERS AND SIGNATURE

• I understand that the fee for 2024 Summer Bike Camp is $375 for the full week per rider.

Yes

• I understand that there is limited space available and that openings will be given on a first-come, first-served basis.

Yes

• I understand that payments are due in full upon submission of this registration form.

Yes

• I understand that payment is non-refundable, except in the unlikely event that the bike camp is cancelled for reasons beyond our control.

Yes

• I understand that no refunds will be made once camp begins.

Yes

• I understand that my registration may be cancelled if payment in full is not received, and that re-registration for the cancelled week is only possible if space allows and if an additional $50 re-registration fee is paid.

Yes

• By signing up for the programs indicated above, I understand and accept the policies and accept responsibility for submitting payments on time.

Yes

• The named minor has my permission to participate in BAY AREA BMXers programs and field trips.

Yes

• I give my permission for any pictures taken of my child participating in BAY AREA BMXers events may be used for publicity or promotional purposes.

Yes

• Please select a size for your rider's jersey:

YXXSYXSYSYMYLSMLXLXXLXXXLXXXXL

• View the Size Chart

Please type your name below to authorize:

Today's Date:

Will you be able to submit payment using Zelle?
YesNo