Newark Bike Project Youth Program Registration
Attention kids ages 9-14! Join us at NBP!
FUN, BIKE RIDES, EXPLORATION, AND COMMUNITY SERVICE
The Newark Bike Project works toward sustainability through community, education and empowerment. Activities include learning bike maintenance and skills, fun rides, and community service projects. Program is $10 per week with scholarships available upon request. If you are registering more than one child, please submit an separate registration for each participant.
Child's Name *
Your answer
Child's Age *
Your answer
Sessions *
Required
Does the child have allergies? *
If yes, please specify allergies below:
Your answer
Please describe any other medical problems, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures), and any dietary restrictions.
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Address *
Your answer
Parent/Guardian Mobile Phone *
Your answer
Parent/Guardian Home or Work Phone *
Your answer
Parent/Guardian Email *
Your answer
Secondary Emergency Contact Name (to be contacted if we are unable to reach parent/guardian) *
Your answer
Secondary Emergency Contact Phone *
Your answer
Secondary Emergency Home or Work Phone
Your answer
Hold Harmless and Consent Agreements
Hold Harmless Agreement: I understand that participation in the activity involves a certain degree of risk. I have carefully considered the risk involved and have given consent for my child to participate in the activity. I understand that participation in the activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. I release the Newark Bike Project and all volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation.
I agree to the terms of the Hold Harmless Agreement *
I also grant the Newark Bike Project to use images taken from the youth activities for promotional or potential funding activities. *
Activity Consent Form and Approval by Parents or Legal Guardian
This form is needed to obtain approval and consent in order to allow minors under 18 years of age to participate in Newark Bike Project (NBP) activities. This form is required for use with tools needed to make repairs to your bicycle and/or any other NBP-associated activity. Additional copies of this form along are available upon request.
Participant has approval to participate in bike repairs/activities performed by the child with assistance from experienced volunteers and/or staff: *
Please describe any restrictions required.
Your answer
Payment Information
Program is $10 per week with scholarships available upon request. Payments may be made online at https://newarkbikeproject.org by clicking on the paypal donation link, phone at (302) 525-6833, or by cash in person.
Payment Information *
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