Register Your Child for Bike Week, June 19 - 23, 2017

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 photo (jpeg or gif) of your child prepared to upload.

Step Two: Payment $250.00

You can choose one of three payment methods:

  1. You can pay now with a credit card
  2. You can mail a check
  3. You are receiving funds from another source but you will 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 junk box, 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 meeting on Sunday, June 18th at Concordia University at 6:00 pm.

Bike Week Registration

For your child to be accepted into the clinic, ALL of the following steps must be completed:

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If same as above, just re-enter
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If none, enter "N/A"
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Rider T-Shirt Size
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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 child’s shoes and back him/her up against a wall.
  2. Place the book or clipboard between the child’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 child’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.
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Rider's Medical Information
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If not applicable, enter "N/A"
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Include information about dietary restrictions and allergies (food related, bee stings) as well as specific instructions related to seizure disorders. We will use this information to ensure that staff and volunteers are matched appropriately with your child and adequately prepared in the event of an emergency during bike clinic. If not applicable, enter "N/A"
Preferred Bike Clinic Sessions

PLEASE NOTE: Due to snow days, Bike Camp may conflict with school in your district. If that is the case, choose session #1 or #5 to avoid scheduling conflicts.

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About the Rider: In order for us to accurately help the rider, we need the following answers completed fully. Please be specific and detailed.
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Bring any of these items to clinic as a motivator.
Riding History
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Attach a photo of the Rider
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Please submit a FULL FACE photo of your child
Waiver / Release
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I/We hereby give consent to Northwest Disability Support (NWDS) and to photograph our child/self to educate others about the programs and services offered by NWDS. 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 NWDS is released from any claims or liability.
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In the event that an emergency requiring medical or surgical care or treatment should arise while our child, 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 NWDS, 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.
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I/We recognize that NWDS/Bike First! cannot accept responsibility for child’s personal property. To help eliminate losses, please tag name inside equipment, clothes or other personal items.
PAYMENT: You must choose one of these payment options
*REQUIRED

Pay now with a credit card via PayPal

If paying now with credit card, please enter 250.00 without a dollar sign in this box and you will be taken to PayPal to enter your credit card information after you click "submit"

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, 2016, your check will be processed.

Electronic Signature
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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.