Bike to Work Day
National Bike to Work Day
Riding your bike to work is a fun way to start your day. Registered riders will be entered into a drawing for $50 gift certificates from Bikesmiths, Bicycle Garage, Revolution Bike and Bean or Salt Creek Cycles. All riders will be rewarded with a free bagel and drink from any of the three Bloomington Bagel Co. shops. Register by submitting the form below by 5/18.

Date: Friday, May 19, 2017

First name *
Your answer
Last name *
Your answer
E-mail *
Please provide a valid e-mail address.
Your answer
Phone number *
(xxx) xxx-xxxx
Your answer
Yes, sign me up. *
By clicking below, you are adding yourself to the participant list
Volunteer Waiver of Liability
The undersigned is the adult volunteer, or is the parent or legal guardian of the volunteer. The undersigned hereby states that s/he understands the activities that will take place in this volunteer position, and that the volunteer is physically and mentally able to participate.

The undersigned recognizes, as with any activity, there is risk of injury. In the event that the volunteer sustains an injury in the course of the program, and the City of Bloomington Parks and Recreation Department is unable to contact the appropriate person(s) to obtain consent for treatment, the City of Bloomington Parks and Recreation Department and/or its employees are authorized to take reasonable steps to obtain appropriate medical treatment. The volunteer and/or his/her parent or legal guardian shall be responsible for the cost of such treatment.

The Undersigned now releases the City of Bloomington, the Bloomington Parks and Recreation Department, its employees, agents, and assigns, from any claims including, but not limited to, personal injuries or damage to property caused by or having any relation to this activity. It is understood that this release applies to any present or future injuries and that it binds the Undersigned, Undersigned’s spouse, heirs, executors and administrators.

The volunteer may be photographed and videotaped while participating in Parks and Recreation activities, and consent is given for the reproduction of such photos or videos for advertising and publicity.

I have read this release and understand all of its terms. I agree with its terms and sign it voluntarily.

Sign Waiver by Entering Name Below
First and last name
Your answer
Never submit passwords through Google Forms.
This form was created inside of City of Bloomington, Indiana. Report Abuse - Terms of Service - Additional Terms