CUSD E-bicycle/bicycle Safety Course & Presentation + Permit Application 24-25 FNMS

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All students must obtain an E-bicycle/bicycle/scooter permit in order to park your E-bicycle/bicycle/scooter on campus. E-bicycle/bicycle/scooter permits are free.

Complete the following items in order to receive your E-bicycle/bicycle permit sticker:

1) Watch/Review the CHP Bike Safety Presentation with a parent/guardian to review all safety rules.

2) Watch the Providence Mission Hospital Safety Video

3) Complete this attestation and submit.

4) After you submit the application, please refer to your school site for their E-bicycle/bicycle permit sticker distribution procedure(s).

The E-bicycle/bicycle permit sticker will be placed on your E-bicycle/bicycle by a staff member in a visible area near the handlebars on your E-bicycle/bicycle. Your E-bicycle/bicycle sticker permit should not be removed. If your sticker is removed, please report this information to the office for replacement and/or investigation.

Please note that E-bicycle/bicycle sticker permits are only valid for the school year they were issued. This means the E-bicycle/bicycle safety course/presentation + permit application must be completed each school year.

Once you have attested to completing the following items, you will submit this form for approval.

Email *

Record my email address with my response

Please review the E-Bicycle/E-Scooter Laws:

STEP 1: Watch/Complete the CHP E-Bicycle/Bicycle Safety Course HERE *

I have completed step 1.

STEP 2: Watch the Providence Mission Hospital E-Bicycle/Bicycle Safety Video below:

Step 3: Review the CUSD E-Bicycle/Bicycle Progressive Discipline

STEP 4: Complete the Attestation Below *

I will complete the attestation below.

Student Last Name: *

Student First Name: *

Student ID Number: *

E-bicycle/Bicycle make, model, and color: *

E-bicycle/bicycle Serial Number and/or description : *

I understand and agree to the following guidelines regarding the use of my bicycle or e-bike on campus: *

I have reviewed the 11 lessons in the CHP E-bicycle/bicycle Safety Presentation with fidelity and understand the contents.

I watched (in its entirety) the Providence Mission Hospital Safety Video

All E-bicycles must be class 1 or class 2. Class 3 E-bicycles may only be ridden by students16 and older.

I will walk my E-bicycle/bicycle in all designated areas on campus at all times and follow all site procedures, rules, and traffic laws.

I will secure my E-bicycle/bicycle with my own lock and will park only in the designated area(s) on campus for E-bicycles/bicycles.

I will wear a secured helmet while riding my E-bicycle/bicycle to and from school.

I understand that my sticker permit can be suspended or revoked if I am riding my E-bicycle/bicycle in an unsafe manner and/or not following the safety rules.

I understand that the school/District is not responsible for any damage, theft, or personal injury as it relates to my E-bicycle/bicycle.

I have read and understand that I will be subject to progressive discipline if I break any of these safety procedures.

Required

Student Signature -- By signing this electronically, you are acknowledging that you have reviewed and agree to the CHP E-bicycle/Bicycle Safety Presentation, the above information, and will abide by these and other E-bicycle/bicycle laws, rules, ordinances, and safety measures.
*

Please type your full name

Parent Signature -- By signing this electronically, you are acknowledging that you have reviewed and agree to the CHP Bike Safety Presentation, the above information, and will help your child abide by these and other E-bicycle/bicycle laws, rules, ordinances, and safety measures.
*

Please type your full name

Providence Mission Hospital- Free Helmet Program

A copy of your responses will be emailed to .

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