Child's Name(Required)
First
Last
How did you hear about Variety?(Required)
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If you are part of an agency, please select one.(Required) Please select CCH ECH Illinois Center for Autism Marygrove Moog Center Ranken Jordan Variety NONE
Address(Required)
Gender(Required) Male Female
Child's Height: Feet(Required) Select a Bike Size for Your Child(Required) Bike Size 12 inch Youth Boys 12 inch Youth Girls 16 inch Youth Boys 16 inch Youth Girls 20 inch Youth Boys 20 inch Youth Girls 24 inch Youth Boys 24 inch Youth Girls 26 inch Youth Boys 26 inch Youth Girls
Select a Helmet Size(Required) Helmet Size Large - 22.83 to 24.4 inches Medium - 21.75 to 22.83 inches Small - 19.68 to 21.75 inches
T-Shirt Size(Required) T-Shirt Size Child XS Child Small Child Medium Child Large Adult Small Adult Medium Adult Large Adult XL Adult 2XL Adult 3XL
Does your bike need training wheels?(Required) Yes No
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COVID-19 Waiver We understand that the child’s participation in this activity involves a risk that the child will get sick by contracting the COVID virus. We also understand that the child, like all children, is vulnerable to problems resulting from isolation. We agree that on balance it is worthwhile for the child to bear the risk of COVID infection in order to be able to participate in the activity.
We understand that it is impossible to both engage in life’s activities and be wholly risk free. We understand that one purpose of Variety is to help children engage in life’s activities.
We understand that while Variety will attempt to conduct the activity with reasonable COVID safety protocols in place, it will be impossible to conduct the activity with all such protocols in place at all times, and such protocols are not 100% effective anyway. COVID risks include at least involvement of many people, resistance to enforcement efforts, and people being in close physical proximity to one another.
We accept that some of those involved in the activity will not be vaccinated, and we will not know who is and who is not vaccinated. We also understand that some children involved in the activity are immune-compromised and cannot be vaccinated.
We agree that if the child develops COVID symptoms we will immediately withdraw the child from the activity, we will inform Variety of the situation, we will have the child tested, and we will keep the child out of the activity until the child’s situation with COVID has abated.
Variety will inform us of any infections of any persons directly involved in the activity, but we understand that Variety reserves the right to continue the activity even if some people involved become infected. We, as parents, retain the right to remove the child from the activity at any time.
In exchange for the child having the opportunity to participate in the activity, we hereby release Variety from all COVID related liability which Variety might have as a result of the child’s participation in the activity. We understand that COVID can be fatal.
We further understand that if we do not sign this release and comply with its terms, and thus agree to bear the COVID related risks of participation in the activity, Variety will not allow the child to participate in the activity. Variety prefers all guardians or parents to sign, but a signature of one is binding.
We understand that the child’s participation in this activity involves a risk that the child will get sick by contracting the COVID virus. We also understand that the child, like all children, is vulnerable to problems resulting from isolation. We agree that on balance it is worthwhile for the child to bear the risk of COVID infection in order to be able to participate in the activity.
We understand that it is impossible to both engage in life’s activities and be wholly risk free. We understand that one purpose of Variety is to help children engage in life’s activities.
We understand that while Variety will attempt to conduct the activity with reasonable COVID safety protocols in place, it will be impossible to conduct the activity with all such protocols in place at all times, and such protocols are not 100% effective anyway. COVID risks include at least involvement of many people, resistance to enforcement efforts, and people being in close physical proximity to one another.
We accept that some of those involved in the activity will not be vaccinated, and we will not know who is and who is not vaccinated. We also understand that some children involved in the activity are immune-compromised and cannot be vaccinated.
We agree that if the child develops COVID symptoms we will immediately withdraw the child from the activity, we will inform Variety of the situation, we will have the child tested, and we will keep the child out of the activity until the child’s situation with COVID has abated.
Variety will inform us of any infections of any persons directly involved in the activity, but we understand that Variety reserves the right to continue the activity even if some people involved become infected. We, as parents, retain the right to remove the child from the activity at any time.
In exchange for the child having the opportunity to participate in the activity, we hereby release Variety from all COVID related liability which Variety might have as a result of the child’s participation in the activity. We understand that COVID can be fatal.
We further understand that if we do not sign this release and comply with its terms, and thus agree to bear the COVID related risks of participation in the activity, Variety will not allow the child to participate in the activity. Variety prefers all guardians or parents to sign, but a signature of one is binding.
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Parent/Guardian 1(Required) RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT Either the child by him or herself, I by myself, or the child and I together wish to participate in the event. There is no charge to us for our participation.
The event will include transportation to and from the site by private car and/or other transportation means, entry into the site, and activities at the site.
I acknowledge that participation in the various phases of the free event will involve the risk of injuries and damages including but not limited to injuries or damages resulting from car accidents and/or falls and/or other mishaps. Injuries and/or damages could include death, personal injury, property damages, loss of services and other injuries or damages.
I understand that unless I sign this release, including all its terms, on behalf of the child and me, the Variety the Children’s Charity of St. Louis will not allow the child or me to participate in the event.
In order to participate in the event, on behalf of the child and myself, I therefore release the officers, directors, agents, affiliates, sponsors, volunteers, successors, assigns and employees of both the Variety the Children’s Charity of St. Louis and the site, and I release all drivers and owners of all vehicles involved in the transportation of the participants, (collectively “the released parties”), from all liability for injuries or damages resulting from activities connected with the event, to the extent those injuries or damages are result of negligent acts.
I further agree to hold the released parties harmless and to indemnify them against any claims brought against them by third parties due to my actions and/or the child’s actions.
On behalf of the child and myself, I thus hereby release the released parties from all claims for damages or injuries for negligent acts connected with the event. I exclude from the release grossly negligent acts, intentional acts, and acts done with malfeasance. I understand this release is quite broad, but I nevertheless accept its terms.
Should the need arise in the course of the event I also hereby give authority to all representatives of the Variety the Children’s Charity of St. Louis and the site to provide reasonable emergency medical care to the child and/or to me. I release all claims for injuries or damages incurred by me or the child in connection with the delivery of such care in good faith. This release is also a condition of participation in the event.
Either the child by him or herself, I by myself, or the child and I together wish to participate in the event. There is no charge to us for our participation.
The event will include transportation to and from the site by private car and/or other transportation means, entry into the site, and activities at the site.
I acknowledge that participation in the various phases of the free event will involve the risk of injuries and damages including but not limited to injuries or damages resulting from car accidents and/or falls and/or other mishaps. Injuries and/or damages could include death, personal injury, property damages, loss of services and other injuries or damages.
I understand that unless I sign this release, including all its terms, on behalf of the child and me, the Variety the Children’s Charity of St. Louis will not allow the child or me to participate in the event.
In order to participate in the event, on behalf of the child and myself, I therefore release the officers, directors, agents, affiliates, sponsors, volunteers, successors, assigns and employees of both the Variety the Children’s Charity of St. Louis and the site, and I release all drivers and owners of all vehicles involved in the transportation of the participants, (collectively “the released parties”), from all liability for injuries or damages resulting from activities connected with the event, to the extent those injuries or damages are result of negligent acts.
I further agree to hold the released parties harmless and to indemnify them against any claims brought against them by third parties due to my actions and/or the child’s actions.
On behalf of the child and myself, I thus hereby release the released parties from all claims for damages or injuries for negligent acts connected with the event. I exclude from the release grossly negligent acts, intentional acts, and acts done with malfeasance. I understand this release is quite broad, but I nevertheless accept its terms.
Should the need arise in the course of the event I also hereby give authority to all representatives of the Variety the Children’s Charity of St. Louis and the site to provide reasonable emergency medical care to the child and/or to me. I release all claims for injuries or damages incurred by me or the child in connection with the delivery of such care in good faith. This release is also a condition of participation in the event.
Parent/Guardian 1(Required) Media Release I also hereby authorize the media and/or representatives of the Variety the Children’s Charity of St. Louis to take photographs and/or videos of the child and me, and to publish and/or air those photographs and/or videos for the purposes of publicity and/or other reasonable purposes.
Photo/Video opt In/Out 
