YBC Volunteer Interest Form - Sharing Wheels Community Bike Shop

Thank you for your interest in volunteering with Sharing Wheels Youth Program. If you have questions, please contact our Youth Program Manager at youthprogram@sharingwheels.org

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Name(Required)

Email(Required)

Phone(Required)

What is your availability for youth volunteering?(Required)

Please provide as much detail as possible about your weekly, scheduled availability.

What skills and experience can you share as a youth volunteer?(Required)

Please include any experience relating to youth work, teaching, bicycle use, and maintenance.

Have you completed Sharing Wheels' volunteer orientation?(Required)

You must be an existing volunteer in order to take part in this program.

Yes

No but I’m willing to join the next New Volunteer orientation to get started

Do you understand that volunteering with Sharing Wheels youth requires a background check?(Required)

Further information will be collected on the next page.

Yes

Do you have any comments/questions for us?

Background Check Information

Please answer YES or NO to each listed item. If the answer is YES to any item, explain in the area provided, indicate the charge or finding, the date, and the court(s) involved. If you do not understand the following questions or if you are uncertain as to your answer to those questions, do not complete this form until such time as you are certain as to your response.

Have you ever been convicted of any crime?(Required)

The term “convicted” means all adverse dispositions, including a finding of guilty, a plea of guilty, a plea of guilty or nolo contendere, an Alford plea, stipulation to the facts, a deferred or suspended sentence, or a deferred prosecution.

Yes, see below

Have you ever had findings made against you in any civil adjudicative proceeding?(Required)

“Civil adjudicative proceeding” means any judicial or administrative adjudicative proceeding that results in a finding of, or upholds an agency finding of, domestic violence, abuse, sexual abuse, neglect, or exploitation or financial exploitation of a child or vulnerable adult under Chapters 13.34, 26.44, or 74.34 RCW, or rules adopted under Chapters 18.51 and 74.42 RCW. “Civil adjudicative proceeding” also includes judicial or administrative orders that become final due to the failure of the alleged perpetrator to timely exercise a right afforded to him/her to administratively challenge findings made by the Department of Social and Health Services or the Department of Health under Chapters 13.34, 26.44, or 74.34 RCW, or rules adopted under Chapters 18.51 and 74.42 RCW.

Yes, see below

Have you ever been the subject of a complaint made to the Office of the Superintendent of Public Instruction regarding whether you have committed an act of unprofessional conduct, as defined in WAC 181-187, or whether you are a person of good moral character and personal fitness as defined in WAC 181 79A-155?(Required)

Yes, see below

If you answered YES to any above question, explain in the area provided, indicate the charge or finding, the date, and the court(s) involved.

Background Check Consent

Full Legal Name(Required)

Please list any current or previous aliases including maiden names:

Date of Birth(Required)

Month

Day

Year

Gender(Required)

Female

Male

Address(Required)

Street Address Address Line 2 City State ZIP Code

Signature of Background Check Consent(Required)

By signing my name below, I understand that a State Criminal History Background Clearance is required and that my service as a volunteer and/or community partner depends on approval. I release Sharing Wheels from any liability as a result of receiving any information. I agree that if I have provided false, misleading, or incomplete information, Sharing Wheels, in its sole discretion, disqualify me from volunteering or terminate my opportunity to volunteer with youth programs. I further agree that if at any time in the future I am convicted of any crime, have findings made against me in a civil adjudicative proceeding, or become the subject of a complaint made to the Office of the Superintendent of Public Instruction, I will immediately notify Sharing Wheels. I understand a copy of the report shall be made available to me upon request.

Sharing Wheels Youth Liability Form

You must agree to these terms before participating in any Sharing Wheels ride, class, program, or event (hereafter “Event”). If you are under age 18, your parent or guardian must agree too, and agree to the Addendum for minor participants.

Read this agreement in full; it affects your legal rights. You are agreeing to assume risks that could result in death or serious injury; to waive all claims against Sharing Wheels and others; to indemnify Sharing Wheels and others; and to consent to emergency medical treatment.

ASSUMPTION OF RISK. I understand that bicycling has risks that could result in serious injury or death. These risks include falling, colliding with vehicles and other cyclists, encountering road hazards like potholes and cracks, crossing train tracks, and being chased by animals, as well as bicycle failures and malfunctions. I freely and voluntarily ACCEPT ALL RISKS of injury, death, or property damage relating to my participation in an Event—even those risks that were caused or contributed to by the negligence of Sharing Wheels, the organizers or sponsors of an Event, volunteers, or other third parties.

WAIVER OF LIABILITY. I hereby RELEASE Sharing Wheels, all other sponsors and organizers of the Event, and the states, counties, and municipalities through which an Event route passes—and their respective affiliates, departments, owners, officers, employees, volunteers, agents, successors, and assigns—from all claims, liabilities, and injuries arising from or relating to my participation in any Event. This waiver includes negligence by any released entity or individual but does not extend to gross negligence, recklessness, intentional misconduct, or any other liability that Washington law does not permit to be excluded by agreement. I understand that I am responsible for my own conduct and decisions while participating in an Event and further agree that this release applies to any claim arising from or relating to my participation in non-bicycling activities during an Event.

INDEMNITY. I agree to DEFEND, INDEMNIFY, AND HOLD HARMLESS Sharing Wheels, WA Bikes, the sponsors and organizers of the Event, and the states, counties, and municipalities through which an Event route passes—and their respective affiliates, departments, owners, officers, employees, volunteers, agents, successors, and assigns—against all claims and all losses and expenses that arise from or relate to my participation in any Event. This indemnity obligation applies to claims of negligence by the indemnitee and includes defense costs like attorneys’ fees. It does not apply to the extent the claim, loss, or expense was caused by the gross negligence, recklessness, or intentional misconduct of an indemnified party.

CONSENT TO EMERGENCY MEDICAL TREATMENT. I consent to all emergency medical treatment that is deemed necessary by first responders and health care providers, until such time that I—or a guardian or person legally authorized to decide for me—can make medical decisions. I agree that I am responsible for all costs of treatment.

MY RESPONSIBILITY FOR SAFETY. I understand that it is not the function of Event organizers or ride leaders to serve as guardians of my safety. I recognize that the routes chosen may be challenging, not necessarily the safest or easiest routes, and that weather, road, or traffic conditions may make a ride more difficult or risky.

REPRESENTATIONS AND WARRANTIES. I represent and warrant that I am in proper physical condition to participate in this event, that I am a sufficiently competent cyclist to handle all road and traffic conditions, and that my bicycle is in safe operating condition. Age. I also represent and warrant that I am age 18 or older, or that a parent or guardian has agreed to the Addendum to Waiver and Release for Minor Participants, included with this waiver.

HELMET REQUIRED. I understand that wearing a helmet that meets the CPSC, SNELL, ASTM, or ANSI bicycle safety standards can reduce head injuries in a cycling crash and that Sharing Wheels requires all riders to wear helmets. I agree to wear such a helmet while participating in any Event. I understand that Sharing Wheels has no obligation to determine if my helmet is suitable for my use.

RULES OF THE ROAD AND OTHER SAFETY RULES. I agree to follow all Event rules, traffic laws, route markers, rules of the road, instructions of event organizers and local authorities, and proper and safe bicycling etiquette at all times. I understand that I may be removed from the Event for failure to do so, and will not be entitled to a refund.

BINDING AGREEMENT. This Agreement is intended to be binding on me, my family, my heirs, my estate, my legal representatives, and my assigns.

DISPUTES AND GOVERNING LAW. This Agreement is governed by Washington law. Any dispute arising from this Agreement or my participation in an Event shall be brought only in the courts of Jefferson County, Washington, or the U.S. District Court for the Western District of Washington, and I agree to the jurisdiction and venue of those courts for any such dispute.

LOST PROPERTY. I understand that Sharing Wheels and its sponsors, officers, employees, volunteers, and agents are not responsible for any lost, stolen, or damaged bicycles, bike components, luggage, or other personal property.

CANCELLATION OR INTERRUPTION OF EVENTS. I agree that Sharing Wheels will not be responsible for any delay, interruption, or other failure to perform, and may cancel any Event for any circumstance beyond its reasonable control. Such circumstances include, by way of example, severe weather, volcanic eruption, earthquake, civil disturbance, forest or other fire, poor air quality, epidemic, terrorist threats, compliance with government requests, inability to deploy necessary equipment or volunteers, roadway or trail closures or construction, and dangerous or impassable roadway or trail conditions. The executive director and the board will be the sole decision-makers as to what if any refund or other accommodation will be made.

I understand and agree that Sharing Wheels, at its sole discretion, has the right to cancel or reroute all or any part of a Sharing Wheels Event due to the occurrence of any force majeure event or credible threat thereof, including but not limited to any unhealthy air quality, fire, earthquake, extreme temperatures, volcano eruption, acts of civil or military authority, casualty, flood, war, terrorist attack, epidemic, insurrection, civil unrest, strikes or other labor activities or any other similar cause beyond the reasonable control of Sharing Wheels, including environmental conditions that might threaten the health and safety of Event participants, volunteers, or staff. I understand and agree that my registration fees and other costs will not be refunded by Sharing Wheels if all or any portion of a Sharing Wheels Event is cancelled or rerouted due to a force majeure event. I will release and hold Sharing Wheels harmless for any costs or damages incurred as result of cancellation or rerouting of a Sharing Wheels Event due to a force majeure event.

SEVERABILITY. If any provision of this Agreement is held invalid or unenforceable by any court of competent jurisdiction, such provision shall be deemed severed from this Agreement to the extent of such invalidity or unenforceability and the remainder of this Agreement will not be affected thereby, each of the provisions of this Agreement being severable in any such instance.

PERMISSION TO USE MY LIKENESS. Unless marked below or communicated otherwise to Sharing Wheels in writing, I permit Sharing Wheels to use my image without payment in any future Sharing Wheels materials should it appear in photos, video, or other recordings taken during an Event.

Signature

By signing below, I am indicating that I have fully informed myself of the assumption of risk, waiver of liability, and consent to emergency medical treatment, and agree to their terms. I acknowledge and accept all the terms outlined in this waiver.

Volunteer Signature(Required)

(write your first and last name to sign this waiver)