2022 InTake Form
Thank you for your interest in InTandem. We look forward to you joining us!

The 2022 InTake Form has three sections: Contact Information, Demographic Information and Important Documentation. Please complete each section below. You will receive an automatic confirmation when you submit the form and an InTandem staff member will follow up with you to begin your Onboarding and Training Process.

Your contact information and emergency contact information will be shared with relevant InTandem staff and volunteer leaders who are responsible for program management, event logistics, communication and safety. Demographic information is used to understand and respond to our cycling community, and its needs and preferences. InTandem does not release personal information to commercial interests or other third parties.

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Contact Information: First Name *
Middle Name
 Last Name *
Address Line 1 *
Address Line 2
City *
State *
Zip Code/ Postal Code *
Preferred Phone Number *
Preferred Email Address *
Emergency Contact Info Name *
Emergency Contact Number *
Emergency Contact Email
How did you find us? *
Demographic Information: How would you like to participate with us? *
How often would you like to ride or volunteer with us? *
How would you describe your fitness level? *
What are your cycling goals? *
Required
Race/Ethnicity *
Gender *
Preferred Pronouns *
Date of Birth *
MM
/
DD
/
YYYY
T-Shirt Size? *
Height (Captains and Stokers of similar height/weight will be paired for safety reasons) *
Weight (Captains and Stokers of similar height/weight will be paired for safety reasons) *
Highest Educational Status Attained *
Is there anything you would like us to know about you?
Important Documentation: Waiver
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, INDEMNITY, AND PARENTAL CONSENT AGREEMENT

("Agreement") for

INTANDEM CYCLING, INC

IN CONSIDERATION of being permitted to participate in any way in Intandem Cycling, INC ("Club") sponsored Activities ("Activity") I, for myself, my personal representatives, assigns, heirs and next of kin:

1. ACKNOWLEDGE, agree and represent that I understand the nature of Bicycling Activities and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further acknowledge that the Activity will be conducted over public roads and facilities open to the public during the Activity and upon which the hazards of traveling are to be expected. I further agree and warrant that if, at any time, I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.

2. FULLY UNDERSTAND that (a) BICYCLING ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH ("Risks"); (b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the conditions in which the Activity takes place, or the NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS AND DAMAGES I may incur as a result of my participation in the Activity.

3. HEREBY RELEASE, DISCHARGE AND COVENANT NOT TO SUE the Club, its respective administrators, directors, agents, officers, members, volunteers and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the "RELEASEES" herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS. And, I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation, expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such a claim.

4. InTandem rides and events may be photographed and/or filmed by InTandem representatives and/or approved agents. Your attendance at these events indicates your consent to be photographed, filmed and/or voice recorded for unrestricted InTandem publicity and promotional uses through all print and electronic communications and media.

5. The terms of this Agreement and the rights, obligations and performance of the parties hereunder shall be governed by the laws of the State of New York as if this were a contract formed and wholly performed within the State of New York without regard to conflict of laws principles. Exclusive venue for any controversy or claim arising out of or relating to this Agreement, or the breach thereof, will be in the United States District Court for the Southern District of New York, or, in the absence of federal subject matter jurisdiction, the courts of the State of New York located in Manhattan, New York. The Parties agree to submit to personal jurisdiction in any of these forums.

6. Please make sure you have read and understood the Ride policies as can be found below
http://bit.ly/InTandemRidePolicy

I HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT, UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS BY SIGNING THIS AGREEMENT, HAVE SIGNED IT VOLUNTARILY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. I AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.
Please enter your name here as acknowledgement that you have read and agreed to the waiver: *
Background: I understand that InTandem Cycling may perform criminal background checks on all participants. The information on this intake form is accurate and I give permission to InTandem Cycling to make inquiry of others concerning my suitability to participate in its activities. *
Required
Photo, Video and Media Release: I hereby agree to be interviewed and/or photographed and/or videotaped and/or recorded for promotional or news documents about InTandem Cycling Inc. I understand that I will not own rights to the resulting text, photography or video, or any benefits derived therefrom. I agree to the use of my s image, name, and/or voice by InTandem Cycling Inc. or media companies discussing InTandem Cycling, Inc. and waive rights to fees associated with such use. Do you agree to the photo, video, and media release form? *
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