Mountain Biking Team

Rider Information

Student Emailrequired

Rider Namerequired

First Name

Last Name

Rider Date of Birthrequired

Must contain a date in M/D/YYYY format

Rider Home Addressrequired

Rider Grade During Upcoming Seasonrequired

Registering forrequired

PreS - 5th Grade ($100.00)

6th - 12th (Summer and Fall) ($150.00)

6th–12th Graders (Summer ONLY) ($100.00)

Other Schoolrequired

Rider Cell Phone Number (if applicable). Parent/Guardian phone numbers will collected later in this form.

Parent/Guardian Information

Name of Primary Contact Parent/Guardianrequired

First Name

Last Name

Phone Number of Primary Contact Parent/Guardianrequired

Email Address or Primary Contact Parent/Guardianrequired

Name of Secondary Contact Parent/Guardian

First Name

Last Name

Phone Number of Secondary Contact Parent/Guardian

Email Address of Secondary Contact Parent/Guardian

Are these contacts also the emergency contacts for the rider during team events?required

Yes

Rider Allergies, Medical Conditions and Medications

Please answer the following questions. Any medications that may be required by the rider should be carried by the rider at ALL team events.

Please list all of the rider's allergies and related medications. If none, please type "None."required

Please list any known medical conditions and provide relevant information for care at team events (warning signs, medications, treatment, etc). If none, please type "None."required

Please provide any other relevant information for the rider's healthy participation in team events.

Volunteer Interest

In order to meet safe coach-to-rider ratios, preference will be given to riders whose parents can volunteer coach at practices.

Is a parent/guardian of the rider interested in volunteering in one of the following ways: ride leader, trailhead monitor, race day setup? Check all boxes that apply.

Ride Coach - ride with another coach and a small group of riders.

Trailhead Parent - remain at trailhead/parking area for duration of practice to provide supervision assistance as needed.

Race Day Support - set up team tent, bring snacks and drinks for the team.

If you selected one of the options above, please provide the name(s) of the parent(s)/guardian(s) interested and their Adult shirt size.

Waivers

Photo Permission: I understand that photos of this camp/clinic/team may be taken for GRCS Adventure Programs promotional purposes. If I have any questions or concerns, I will contact Kevin Van Harn (kvanharn@grcs.org), Adventure Programs Coordinator. required

Yes

Liability: As a parent or guardian, I understand that participation on this team is voluntary and that participation and payment of the team fee does not imply liability, either personal or in regard to property, on the part of any coach, staff, or Grand Rapids Christian Schools. I authorize the coaches of the team to act for me according to their best judgment in any emergency requiring medical attention and release, exonerate, and discharge the team, its coaches, staff, and Grand Rapids Christian Schools from any and all actions known or unknown for any injuries or sickness my child incurs while at a practice, race, or team activity. required

Yes

Additional Shirt Orders

If you are interested in purchasing additional mountain biking t-shirts (you do NOT need to include rider and volunteer shirts ), please complete the following section. Shirts are $20 each.

Number of additional Shirts

1 ($20.00)

2 ($40.00)

3 ($60.00)

4 ($80.00)

Payment Information

Please complete captcha below to proceed to payment selection.

Please select a payment typerequired

Credit Card

Billing Addressrequired

Address

City

State/Province

Country

Zip/Postal Code

Cardholder Namerequired

First

Last

Expirationrequired

Month

Year

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Rider Information

Parent/Guardian Information

Rider Allergies, Medical Conditions and Medications

Volunteer Interest

Waivers

Additional Shirt Orders

Payment Information

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