iCan Bike Participant Application Form

Cost of program: (helmet & t-shirt included)

$25 application fee (Due upon completion of your application. This fee is
non-refundable unless we are unable to accommodate your rider. Application
fee will be applied towards total cost of camp.)

$50 for Foundation "Family Members"
$150 for Foundation "Community Members" and non-members

Once your participation is confirmed you will have 10 days to submit your payment.

Award Letters will be sent out by July 1, 2017.

    Personal Information

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    Physical Information

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    Unique Ability Information

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    Medical Information

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    Choose a Session

    Session 1: 8:30 am - 9:45 am Session 2: 10:05 am - 11:20 am Session 3: 11:40 am - 12:55 pm Session 4: 2:00 pm - 3:15 pm Session 5: 3:35 pm - 4:50 pm
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    PHOTOGRAPH AND/OR VIDEO RELEASE

    I give permission for the above rider to be photographed and/or videotaped in print or electronic media by Down Syndrome Foundation of Florida or third parties acting on behalf of Down Syndrome Foundation of Florida. I acknowledge and agree that photographs and videos may be edited and used in whole or in part as desired for the purpose, which may be produced, duplicated, distributed and used for informational, promotional or other public purposes. I understand that photographs and video are not my property and there will be no compensation to me. I understand and authorize the use in writing or otherwise the name or identity of the above rider.
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    iCan Bike Program Description

    The objective of iCan Bike is to teach individuals with disabilities to ride a conventional two wheel bicycle without training wheels. Our program uses specialized equipment, coaching and encouragement to reach this goal. Through the use of our equipment, we gradually introduce the instability of the bicycle until the participant “discovers” how to ride a bike. Staff from iCan Bike, in partnership with Insert your organization name, conduct the program. The iCan Bike staff will supervise the progress of the participants and direct the work of volunteer “spotters”. They will also make necessary adjustments to the trainer bikes for each participant. Participants will attend one session (75 minutes) per day for a total of five days. During the session each participant will ride indoors on an adapted trainer bike or outdoors on a conventional bike once they have achieved that skill level. Participants are required to wear a properly fitting helmet when they are on a bike. Bicycling involves a physical activity on moving equipment. It is inevitable that circumstances will arise when it is necessary to physically touch, hold, or even grab your participant. This often occurs as we place feet on pedals, lift a chin to improve forward vision, place a hand on the back to increase pedaling speed, or catch a participant who might be falling. These activities occur in a public setting and are for therapy purposes. If you or your participant objects to being touched you are advised to not enroll in this program. In spite of extensive safety measures, bicycling involves the risk that a participant will fall or collide with an obstacle or another rider. The result of a fall or collision could be a mild injury such as a skinned knee or a serious injury such as a broken bone or head injury. By enrolling in this program you acknowledge that you are aware of, understand and accept this risk. We strive to teach every participant to become an independent bike rider, but we are not successful in all cases. The outcome cannot be predicted and is not guaranteed. We do promise to make every effort to provide the best equipment, staff and environment to assure each participant’s highest level of success possible.

    Rider Information

    Please provide the following information for use by camp staff & volunteer spotters.
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