All participants are required to adhere to all of the following rules. Failure to comply with these rules will result in termination of your participation. 

1. Conduct: All participants are required to follow directions, to use positive words, exhibit positive actions, and to keep a positive attitude.

2. Questionable Items: Our staff retains the right to confiscate any potentially dangerous or illegal items that may be in your possession. Disciplinary and/or legal action will be taken where necessary.

3. Interaction: All participants are to interact with others in a friendly and respectful manner, following all rules.

4. Assumption of Risk: All bikes will be purchased or earned through community service projects including picking up trash from the neighborhood streets. All participants are instructed and agree NOT to pick up dangerous or potentially dangerous items such as (but not limited to) broken glass, needles, nails, or anything else that could cut or injure them. Participants understand that participation in bicycling activities involves inherent risks, including the risk of serious injury or death. By signing this document, the participant, and their parent/guardian, assume those risks and any other risk incidental to the program. 

5. Release of Responsibility: In consideration of the opportunity to participate in this program and its activities, the participant and their parent/guardian will not hold The Village Wrench, its leadership team, volunteers, employees, agents or other involved organizations responsible or legally liable, for any injuries to the participant or property, or the results thereof, incurred and suffered as a result of the participant’s participation in any of the activities, programs, or field trips. 

6. Willingness to Follow Instructions: All participants agree to use the equipment and facilities as instructed by The Village Wrench’s leadership and volunteer team. The participant understands that any failure to do so on their part may prevent their participation in these activities. 

7. Fitness to Participate: The participant and parent/guardian certify that the participant has no physical or cognitive condition that would prohibit their participation in these activities. If they now or have been in the past under treatment for any physical conditions that may limit their participatiton, they will discuss it with the program supervisor and yield to his/her judgment as to whether they should participate. The participant understands that their participation in these activities is entirely voluntary and that they may excuse themselves from participation if they so desire. 

8. Permission to Treat: The participant and parent/guardian give permission to The Village Wrench volunteers and staff to administer routine non-emergency medical care for the participant. The participant agrees to disclose to the Village Wrench and its volunteers and leadership team any medical or other conditions that would prohibit the administration of such routine non-emergency medical care.

9. Loss Prevention: The student’s belongings are the student’s responsibility to keep track of and not lose. The Village Wrench is NOT responsible or liable for anything lost or stolen. Unauthorized items will be confiscated and returned to participant’s parents.

Name *
Name
Date *
Date
Address *
Address
Date of Birth *
Date of Birth
Gender
Phone *
Phone
Parent / Guardian Name
Parent / Guardian Name
STUDENT / PARTICIPANT SIGNATURE
By submitting this application and allowing your child to participate in The Village Wrench activities, it is understood that you are aware that your child’s photograph may be taken, and you give permission to The Village Wrench to use such photographs on its website(s), in newsletters, print material, social networks, or other forms. If you wish for your child’s image to not be used, please indicate so on this application.
By submitting this application and allowing your child to participate in The Village Wrench activities, it is understood that you are aware that your child’s photograph may be taken, and you give permission to The Village Wrench to use such photographs on its website(s), in newsletters, print material, social networks, or other forms. If you wish for your child’s image to not be used, please indicate so on this application.
STUDENT - Typing your name here serves as your electronic signature.
Parental Consent
As the parent or guardian of
As the parent or guardian of
I understand the rules and take full responsibility for my student’s actions while present at The Village Wrench or during any events. My signature will also serve as permission to the above-mentioned student to be at The Village Wrench.
I understand the rules and take full responsibility for my student’s actions while present at The Village Wrench or during any events. My signature will also serve as permission to the above-mentioned student to be at The Village Wrench.
Typing your name here serves as your electronic signature.
Photograph Release
Photograph Release
By submitting this application and allowing your child to participate in The Village Wrench activities, it is understood that you are aware that your child’s photograph may be taken, and you give permission to The Village Wrench to use such photographs on its website(s), in newsletters, print material, social networks, or other forms. If you wish for your child’s image to not be used, please indicate so on this application.
Do you give consent for your child's photograph to be used?
ELECTRONIC SIGNATURE CONSENT
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Participation / Rules of Participation. *