Register for Bike Week, June 18 - 22, 2018

To be accepted into the clinic, ALL of the following steps must be completed:

Step One: Fill Out Online Registration Form Below

Please allow 20 - 30 minutes to complete the form. Fill out every field carefully. Have a FULL FACE jpeg photo prepared to upload.

Step Two: Payment

Cost of a full week of Bike Camp for first-time campers is $250
Cost of a full week of Bike Camp for returning campers is $200
Cost of the 3-day Quick Start / Refresher Course is $150

You can choose one of three payment methods:

  1. Pay now with a credit card via PayPal (You will be taken to the PayPal site to complete the transaction after the form is submitted-- a PayPal account is not required)
  2. Mail a check
  3.  Receive funds from another source but mail a check now to hold your spot

Step Three: Receive email confirmation

After payment is processed and ALL required pieces are complete, we will send you participant information and confirm your rider's session via e-mail. Please check your spam/junk folder, as this has been a problem in the past.

Step Four: Plan for Orientation:

If you are accepted into Bike Week, you will need to attend a MANDATORY parent/caregiver meeting on Sunday, June 17th at Concordia University Gym at 6:00 pm.

Bike Week Registration
Registration is for...
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Rider T-Shirt Size
T-Shirt Size
Youth or Adult?
Rider Measurements

Very important! Accurate measurements provide essential information for bike size selection.

To measure inseam accurately, you will need a tape measure and a large clipboard or large, thin book.

  1. Remove rider’s shoes and back him/her up against a wall.
  2. Place the book or clipboard between the rider’s legs with the edge square against the wall so that it acts as a T-square.
  3. Raise the book ALL the way while maintaining the T-square effect. Make sure rider’s heels remain on the floor. The measurement needs to be from the pubic bone to the floor.
  4. Measure the distance from the top of the clipboard/book to the floor.
Rider's Medical Information
Include information about dietary restrictions and allergies (food related, bee stings) as well as specific instructions related to seizure disorders. This information helps ensure that staff and volunteers are matched appropriately with your child and adequately prepared in the event of an emergency. If not applicable, enter "N/A"
Preferred Bike Clinic Sessions
Indicate Your First Choice
Indicate Your Second Choice
About the Rider: Please be specific and detailed
Bring any of these items to clinic as a motivator.
Riding History
Attach a photo of the Rider
Please submit a FULL FACE photo of the applicant
No file selected
Waiver / Release
Photographic Release
I/We hereby give consent to Northwest Disability Support and to photograph the participant to educate others about the programs and services offered by Northwest Disability Support. Among the uses contemplated are illustration of articles in newsletters, in profiles that contributors receive, in brochures, to illustrate services discussed on the web site, in displays at community fairs, to publicize local programs, to make professional presentations, to conduct research on teaching techniques and equipment used at the clinic, and to publicize the equipment and teaching methods used. In giving approval, I/we understand it is without consideration of compensation of any kind, and Northwest Disability Support released from any claims or liability.
Medical Release
In the event that an emergency requiring medical or surgical care or treatment should arise while the participant is attending the Bike First! program, and I/We ARE NOT PRESENT TO MAKE MEDICAL DECISIONS, I/we give consent for Bike First! clinic staff to select and designate nurses, physicians, emergency medical staff (EMS) and surgeons to furnish such medical and/or surgical care as, in the judgment of a physician and/or surgeon holding a physician’s certificate issued by the Board of Medical Examiners of the State of Oregon may be needful and proper. I/We absolve Northwest Disability Support, Bike First!, nurses, physicians, EMS personnel, and surgeons selected and designated by them, from any and all liability for their acts rendered in good faith.
Personal Property
I/We recognize that Northwest Disability Support/Bike First! cannot accept responsibility for participant’s personal property. To help eliminate losses, please tag name inside equipment, clothes or other personal items.
Choose a payment option
Please indicate your payment method

Pay now with a credit card via PayPal
If paying now with credit card, please enter the correct amount without a dollar sign:

First-time camper 250.00
Returning camper 200.00
Quick Start / Refresher camper 150.00

You will be prompted to enter your credit card information after you submit this form. You do not need a PayPal account to complete the transaction.

Enter amount without a dollar sign, eg. 250.00

Pay by check

Make checks payable to NWDSA Bike First!

Mail to:
Northwest Down Syndrome Association
11611 NE Ainsworth Circle
Portland, OR 97220 


Payment from another source

You must send a check to confirm your spot at Bike Week. The check will be held but not processed. If payment is not received from another source by June 1st, 2018, your check will be processed.


Electronic Signature
Signature
By checking the "I Accept" box, you are signing this Registration Form electronically ("E-Signature"). You agree your E-Signature is the legal equivalent of your manual signature on this Registration Form, as if actually signed by you in writing.

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