greaterakron oh logo



iCan Bike - Rider Registration Form
Parent Orientation: Sunday, July 14 at 4pm
Camp Dates: July 15-19, 2024
Jackson High School
7600 Fulton Dr NW, Massillon, OH 44646


Thank you for your interest in the 11th Annual iCan Bike Camp sponsored and hosted by the Autism Society of Greater Akron. We are proud to partner with Jackson High School and iCan Shine to bring this highly specialized camp to our community.  We look forward to working with you and your rider in this endeavor to learn to ride a two-wheel bicycle independently.

Requirements for Participation

These are set by iCan Shine to ensure riders are safe and to give them the best chance for success. Riders must meet all the criteria below:

•  Minimum of 8 years of age •  Able to sidestep to both sides 
•  Have a disability •  Able to attend camp all 5 days
•  Able to walk without assistive device •  Maximum weight 220 lbs.
•  Willing and able to wear a properly
   fitted bike helmet
•  Minimum inseam of 20” (measure from       floor while rider is wearing sneakers)

 

 

 

 

 

 

 
NOTE: Dropping-off Riders at the program is not permitted. A parent, legal guardian or other adult authorized to take responsibility for the Rider (e.g. grandparent) must remain on site for the duration of the 75-minute program.

***All fields are required. Registration will not be accepted and a spot will not be held if this form is incomplete.***

PARENT / GUARDIAN INFORMATION

 

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

RIDER INFORMATION

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

DISABILITY INFORMATION

Invalid Input

Invalid Input

Invalid Input

HEALTH INFORMATION

Invalid Input

Invalid Input

CHOOSE SESSION TIME

Please select your session times in order of preference.  Only mark the sessions you are able to attend.  We will do our best to honor your first choice, but we do have scheduling limitations for each session based on the adaptive equipment. 

 

Invalid Input

Invalid Input

Invalid Input

ORIENTATION FOR PARENTS / GUARDIANS

An orientation meeting will be held Sunday, July 14 at 4pm at the Jackson High School Gym.. This is an important time to learn about the program, what you can do at home both during the week and after the camp concludes to help your participant achieve the highest level of success. You will receive critical information regarding selecting an appropriate bike and bike helmet. There will be question and answer time as needed. Please arrange your schedule so you can attend. This is the only time this information will be presented. Riders are discouraged from attending so you can focus on the discussion, but we realize this is not always possible.

Invalid Input

RIDER INFORMATION

(NOTE: All of the following Rider information is disclosed orally and/or in print form to the Rider’s Assigned Volunteers. Please do not include any information below that you do not consent to being disclosed to the Rider's Assigned Volunteers)

This information helps camp staff & volunteer spotters assigned to work directly with the Rider understand and better serve the individual needs of the Rider.

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Please answer each of the following questions.  Include any information that will help us work better with Rider.

What strategies do you use to promote positive behavior and/or discourage negative behavior that will enable us to work safely and successfully with the rider?

Invalid Input

What are favorite activities, movies, music, hobbies or other interests of the rider?

Invalid Input

Suggested motivators if needed.

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Through participating in this iCan Bike program, what are your expectations for your rider?

Invalid Input

Rider Acknowledgment & Liability Release

The undersigned hereby agrees to the following:

ASSUMPTION OF RISK:

I am the above indicated Rider’s parent or legal guardian and, for myself and on behalf of said Rider, have fully read the accompanying iCan Bike Rider Registration Form and the related materials made available to me describing the iCan Bike program (“Camp”), and I am aware of, understand, and assume the unavoidable risks of the inherently dangerous activity of bicycling, which involves movement and physical exertion that could result in, but not be limited to, severe bodily injury or death.

RELEASE OF LIABILITY:

In consideration of iCan Shine, Inc. (“iCan Shine”), its affiliates Autism Society of Greater Akron and Jackson High School allowing the above named Rider’s and MY participation in the Camp, I, for myself and on behalf of said Rider, our heirs, administrators, personal representatives or assigns, hereby agree to release, indemnify, hold harmless and discharge iCan Shine, its owners, agents, employees, officers, executives, directors, representatives, affiliates, assigns, Rainbow Trainers, Inc., Autism Society of Greater Akron, Jackson High School and their volunteers, agents, employees, and officers of and from all claims, demands, causes of action, and liability, whether the same be known or unknown, anticipated or unanticipated, even if caused, in whole or part, BY THE NEGLIGENCE OF ANY OF THE FOREGOING. I further agree that I shall not bring any claims, demands, legal action and causes of action, against iCan Shine and/or any of the foregoing for any economic and non-economic losses due to bodily injury and/or death and/or property damage, sustained by said Rider or ME in relation to the facility and/or operations of the Camp, which shall include, but not be limited to, riding, driving, training, handling, or otherwise being near both conventional two-wheeled bicycles as well as the adapted and/or modified biking equipment used by iCan Shine at the facility during the Camp, whether or not such bicycles and equipment are owned by iCan Shine, or in the care, custody, or control of iCan Shine.

INDEMNIFICATION:

If, despite this release, I, the above named Rider or anyone on said Rider’s behalf makes a claim against iCan Shine or any of the foregoing, I agree to indemnify and hold harmless iCan Shine and the foregoing from any litigation expenses, attorney’s fees, loss, liability, damage, or cost that they may incur due to the claim(s) made against iCan Shine and the foregoing related to any of the activities or associated activities outlined above.

Further, I hereby expressly acknowledge that photographs and/or videos of said Rider could be taken by parties outside the control of iCan Shine and Autism Society of Greater Akron or Jackson High School in connection with participating in the Camp. I acknowledge that iCan Shine and Autism Society of Greater Akron and Jackson High School have limited or no control over such activities of third parties and have no control over any editing and/or use of such photos and/or video footage.

Media and Data Collection Release

I give permission for said Rider to be photographed and/or videotaped and later published in print or electronic media by iCan Shine or Autism Society of Greater Akron, Jackson High School or third parties acting on behalf of iCan Shine or Autism Society of Greater Akron, Jackson High School. I acknowledge and agree that photographs and videos may be edited and used in whole or in part as desired for these purposes, and may be produced, duplicated, distributed and used for informational, promotional, or other public purposes. I understand that photographs and videos are not my property and I will not be compensated for them. I understand and authorize the use in writing or otherwise the name or identity of said Rider.

Further, I understand that data collected from this program will be used to help the camp operate effectively relative to appropriate progressions, bike sizing and behavior management. I acknowledge that I may be contacted in the future for follow up information pertaining to rider progress, status or for other requests to support the future development and success of the program.

Refund Policy

The registration fee for participating in iCan Bike Akron is due with the registration form. The camp fee is refundable less a $25.00 administrative fee if notification of cancellation is received by June 28, 2024. After June 28, refunds granted based on our ability to fill the space with a new participant. Sometimes participants learn to ride in less than the 5 sessions of camp. No refunds, either full or partial, will be given in this circumstance.

By typing my name in the box below, I confirm that I have read and agree with the above policies and agreements as they are required for rider participation.

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input