Naperville Central Fellowship of Christian Athletes 2005 Bike Trip Contract

	2005 Bike Trip Home
Mission	Supplies	Trip Memories

Schedule	Cost List	Contract

	Pictures

Mission: I, the participant will do all I can to fulfill the mission of our bike trip.

Prayer: I, the participant agree to find 10 people to pray for me daily while I'm gone.

Training: I, the participant commit to preparing physically for 2005 Bike Trip, so that it will be a pleasant experience for the other participants and myself. I have read the recommended training schedule and will use it to prepare adequately.

Payment: I, the participant agree to pay $285 for the trip. I have read the page involving the costs for the trip. I understand that there are out of pocket expenses involved on the trip which could reach $50. Checks should be made out to Naperville Central FCA.

Rules and Regulations: Participants will be expected to commit to a verbal contract at the beginning of the program. This contract will include a commitment to guidelines of behavior for the safety and well being of the individual and group. These include the prohibition of all forms of tobacco, alcohol and drugs, cooperation with group leaders and other members of the group, and the commitment to not become involved in cliques and exclusive one-on-one relationships with excessive displays of affection. The trip leaders will handle any discipline problems in a manner as seen fit. If a participant is dismissed for failure to cooperate, parents will be called and are responsible to pick up their child immediately. If a participant is dismissed, it will be at the parent’s expense and no refund will be given.

Liability: Naperville Central Fellowship of Christian Athletes (NCHS FCA) is not liable for bodily injury or property damage as a result of (but not limited to): physical exertion for which a participant is not prepared; forces of nature; travel by auto, or other conveyance, or by bicycle, foot or other form of active or adventure travel; consumption of alcoholic beverages; civil unrest; terrorism; breakdown of equipment; lack of or limited access to medical attention in remote locations; and the adequacy of medical attention once provided. NCHS FCA reserves the right to make route modifications as necessary to improve the quality of the trip or to accommodate the comfort and well being of the participants.

Release of Liability: We the undersigned are aware that traveling by auto, foot, bicycle or other conveyance contains some inherent risks of illness, injury or death. We the undersigned recognize that such risks may be present before, during and after the trip by participating in 2005 Bike Trip under the arrangements of NCHS FCA. In consideration of, and as part payment for, the right to participate in the trip, and activities, services and food arranged for the participant by NCHS FCA, we the undersigned have and do hereby fully assume all risks of illness, injury, or death, and hereby release and discharge NCHS FCA, from all actions, claims, or demands for damages resulting from participation on the trip. We the undersigned solely agree to take responsibly for any damages, loss or theft of bicycles and accessories during the participants bicycle-touring period. We the undersigned agree that the foregoing obligation shall be binding upon us personally, as well as upon our heirs, executors and administrators and all members of our family, including any minors accompanying the participant that is undersigned. We the undersigned agree to waive and relinquish all claims, including unintentional negligence, that the participant or the parent/guardian may have against NCHS FCA and any of its leaders as a result of participating in 2005 Bike Trip. We the undersigned have carefully read this agreement and fully understand its contents and am aware that this is a release of liability and a contract between us and NCHS FCA, and sign it of our own free will.

Participant's Name______________________ Participant’s Email________________________

Participant's Signature______________________________ Date_______

Parent/Guardian s Name(s)_______________________________________

Parent/Guardian’s email _________________________________________

Parent/Guardian Signature___________________________ Date_______

Address________________________ City_____________ Zip__________ Phone__________

Medical Release Form for the NCHS FCA Bike Trip

Participants Name______________________________________

Date of Birth ______________ Home Phone___________________________

Address____________________________ City ________ Zip__________

In case of emergency, please call this person _________________________

Best Phone Number (______)__________(is this legible?)

Second Best Phone (______)__________

Yes I have a third (______)__________

Second Best emergency person _____________________ at this number (_____)____________

Doctor's Name ______________________ Phone (_____)____________

Please answer the following:

1. Please fill in the date of last TETANUS BOOSTER_____________________

2. Please check pertinent medical information

___Special Diet ___Seizures

___Asthma ___Drug Reactions

___Physical Restrictions ___Heart irregularity

___Allergic Reactions (Bee stings, etc) ___Aspirin or Ibuprofen problems

___Other

Please clarify if you checked anything above _____________________________________________________________________________________

_____________________________________________________________________________________

If any of the above information needs the attention of the adult leaders of the NCHS FCA Bike Trip, this will need to be spelled out by a physician as well as signed by the parent.

In the event of an emergency, the adult leaders of the NCHS FCA Bike Trip will make every effort to contact the parent/guardian of the above named participant. I, the undersigned parent or guardian of the above named participant, give permission for x-rays, suturing of lacerations, and other emergency treatment deemed necessary by the attending physician in an emergency room or at a doctor's office.

Participants Signature _________________________________________ Date_______

Parent or Guardian Signature______________________________________ Date_______