Spring 2019 FLYRS Registration
Participant's Name *
Your answer
Participant's Current Age *
Your answer
Participant's Current Grade *
Participant's Gender
Participant's Race/Ethnicity (please mark all that apply)
FLYRS Group (please refer to the program descriptions to ensure you sign up for the most appropriate leveled group) *
I have read the program information and confirm that my child has the skill set required for the group that they are registered for. *
Required
Participant Shirt Size *
Parent Name *
Your answer
Parent Phone Number *
Your answer
Parent E-mail *
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Other Parent or Alternate Adult Contact Name *
Your answer
Other Parent or Alternate Adult Contact Phone Number *
Your answer
Any allergies, health conditions, or other issues we should know about regarding the participant? *
Your answer
I give permission for my child to be photographed and/or video-recorded during FLYRS sessions, and for those artifacts to be used for either instructional or promotional purposes. *
The push bike group is $80. All other FLYRS groups are $110 per child, and siblings are $100. Your child’s spot will be reserved as soon as you submit (1) this completed online registration form, (2) the completed online waiver below, and (3) full payment. The preferred method of payment is via the Venmo app -- please send payment to "Flagstaff Youth Riders" / "@FLYRS" on Venmo and indicate your child(ren)'s name(s). If you prefer to send a check, please make it payable to FLYRS and mail it to: FLYRS, 5135 N Agave Trail, Flagstaff, AZ, 86001 and send us an email (flyrsmtb@gmail.com) letting us know a check is on its way. *
In consideration of being allowed to participate in any way in the FLYRS program, its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that: 1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the FLYRS leader; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the FLYRS, the Executive Director, the Board members, FLYRS coaches and volunteers, and USA Cycling, Inc., their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. This is to certify that I, as parent/legal guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my child and our heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. *
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