Clinic Registration Form - Intro to Riding 1Registration2Personal Information3Cycling BC Licence4Payment Please read carefully I hereby release Kits Energy Training Inc. (Kits Energy) and any of the instructors or leaders working or volunteering with the company, from all liability in connection with the cycling clinic offered. This release has legal consequences and I have been advised to read it carefully before signing. I acknowledge that cycling is an inherently dangerous sport and I fully realize the dangers of participating in bike training rides. I fully assume the risks associated with participation including, by way of example and not limited to the dangers of colliding with pedestrians, cars or other riders. I understand and agree that situations may arise during training rides and instruction, which are beyond the immediate control of Kits Energy and I will not hold any of these parties responsible for any injuries, losses or other damages suffered by me. I take full responsibility for myself and agree to ride in a manner that will not endanger myself or others. I agree to follow the rules of the road at all times. I accept responsibility for the condition and safety of my equipment such as my bicycle and all of its components, wheels and tires. I will wear an ANSI approved hard shell helmet on all training rides and while participating in coaching or instruction clinics. I agree that I am fit and healthy to participate in a cycling training program and do not have any injuries that will be made worse by participating. I understand that I can refuse participation in any activity at any point in time. I agree that I will not attend any workouts if I am feeling any symptoms of fever or sickness of any kind, and/or have not followed the most current quarantine requirements. This release may not be modified orally, and a waiver of any provision shall not be construed as a modification of any other provision.Signature(Required)Registrant's signature. By providing your signature, you are agreeing to the terms and conditions of the release statement.Date(Required)Today's date MM slash DD slash YYYY Name(Required) First Last Gender Female Male Nonbinary Birth Date(Required)MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email(Required) HiddenAdd my email address to the Intro to Riding distribution list to help with communication and organize group rides. Yes No Mobile Phone(Required)Address(Required) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Emergency Contact Name(Required) First Last Emergency Contact Mobile Phone(Required)Additional InformationAllergies Medications HiddenCycling Club Affiliations HiddenFor this season I am setting a goal to participate in the following cycling events:Check all that apply Ride Don't Hide 60k in June Axel Merckx Cortofondo in July Kits Energy Seymour climb in July Valley Fondo in July Tour de Victoria in August GS Cypress Hill Challenge in August Ride to Conquer Cancer in August Whister MedioFondo 55k in September OTHER It is a requirement for all Kits Energy club members to have a Cycling BC Provincial Ride Membership or Race License. Do you already have a Cycling BC license or membership?(Required) Yes No Yes, I have a Cycling BC LicenceCycling BC Membership Number(Required)I am fully aware and understand that before I can join or participate in the Kits Energy Cycling club, I must hold a current Cycling BC Provincial Ride membership or license. Below is my Cycling BC number. No, I do not have a Cycling BC LicenceIn order to proceed with your registration, it is a requirement to own a minimum of a Provincial Ride membership which is purchased through the CCN website. Please click the button below. The Cycling BC website will open in a new tab where you can purchase your licence or membership." GET CYCLING LICENCE After you have finished your purchase, please copy and paste your membership number below to proceed with the Kits Energy Cycling club registration.Cycling BC Membership Number(Required)Please enter your membership number to confirm your licence or membership purchase. Kits Energy ProgramsCycling Clinics - General Registration(Required)Please note that all registrations are non-refundable and non-transferable unless the class has been canceled due to not enough registration or COVID-19 restrictions. Intro to Riding on Tuesdays with Kristina ($275.00) Tax Price: $ 0.00 CAD Your TotalPlease note that all registrations are non-transferable and non-refundable, unless cancelled due to lack of registrants. PLEASE NOTE. Once you hit REGISTER, you will leave the Kits Energy Registration page and be directed to PayPal. Upon making your payment, you will receive an email, confirming your registration and providing more details for your season. Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name EmailThis field is for validation purposes and should be left unchanged.