I Can Bike Information about the program

Transcription

1 I Can Bike Information about the program I Can Bike is a not-for-profit organization whose mission is to teach individuals with disabilities to ride a conventional two wheel bicycle and become lifelong independent riders. This achievement, in turn, creates a gateway of opportunity, helping them gain assurance and self-reliance in many other aspects of their lives. The program uses unique adapted bicycles to help children gain the skills and confidence they will need as they gradually transition to a regular two wheeled bicycle. This program is appropriate for people with a disability, ages 8 and up, who are able to walk without an assistive device, and who have been unsuccessful at learning to ride a two wheeled bicycle. Examples of participants include people with Cerebral Palsy, Autism Spectrum Disorder, Down syndrome, etc. This summer, KidsAbility will host the program in partnership with the City of Guelph, and with financial support from the Goodlife Kids Foundation. Participants ride for 75 minutes a day for five days. Participants are able to take breaks as required, but will be encouraged to spend as much time on their bikes as possible. The more time spent pedaling, the more likely a successful transition to a two wheeled bike! Here are some things to consider when deciding if this is the right program for your child: To be an independent rider, one must be able to start, ride, and stop a bike safely and independently. Participants should be able to put either leg out to the side to balance the bike when they come to a stop! This program teaches riders the physical skills of balancing a bike. Please consider your child s safety awareness. If your child does not possess the safety skills to ride independently in the community, are you prepared to supervise them while cycling in safe places such as trails? Children who are motivated to learn to ride a bike, or who can be easily motivated to keep working tend to progress very well. If your child has more significant balance challenges, they will need to work hard to learn how to ride. They may need to do the program twice. We welcome them to participate, and will celebrate every gain that they make, but be prepared that it may take them longer to learn. If your child has poor fitness, poor safety awareness, or significant balance challenges, feel free to give us a call to explore if this program is a good fit for your child. Children who are not yet eight years old will be placed on the waitlist. If spaces are available as of the registration deadline (June 1 st ), they may register for the program. For more information, contact Heather Granger at x 6235 or hgranger@kidsability.ca 1

2 Date Received: Rider Registration Form KidsAbility Centre for Child Development Parent Orientation: Sunday July 14, 2013, 3:00 pm Program Dates: July 15-July West End Community Centre, 21 Imperial Road S, Guelph Cost: $ per participant (Subsidy Available) Return Applications: As soon as possible to ensure your spot in the program Requirements for Participation: Please check all that apply 8 years of age or older Able to sidestep to both sides With a disability Inseam is 20 or greater Able to walk without assistive device Weighs less than 220 lbs. Able to wear a properly fitted bike helmet ** You may be required to attend an eligibility screening. ***All fields are required. Registration will not be accepted if this form is incomplete.*** Personal Information Participant First Name: Gender: Date of Birth: Parent/Guardian First Name: Last Name: Last Name: Address: Home Phone: ( ) Work Phone: ( ) Cell Phone( ) Preferred method of contact: Home Work Cell Street: City: Provine: Postal Code: Emergency Contact: Name: Phone: 2

3 Physical Information Height: inches Weight: lbs. Inseam: inches (measure from floor) T shirt size: circle Youth or Adult and Small Medium Large XL 2XL Disability Information Primary diagnosis: Secondary diagnosis: Please provide detailed information regarding the diagnosis that will help us work with the participant effectively: Medical Information Food allergies: Yes or No (If yes, please explain: ) Please explain any medical conditions or health concerns and any special instructions: Choose A Session Please number each session in order of preference. Only mark the sessions you are able to attend. Session 1 Session 2 Session 3 Session 4 Session 5 8:00 am 9:15 am 9:35 am 10:50 am 11:10 am 12:25 pm 1:25 pm 2:40 pm 3:00 pm 4:15 pm Will you be able to attend all five days of camp? yes no 3

4 Rider Information Please provide the following information for use by camp staff & volunteer spotters Rider s Name: Nickname: Age: Diagnosis (optional): Please highlight the appropriate box as it relates to the rider Can communicate his/her needs When upset can manage his/her emotions Consistently follows simple directions Cooperates with others Comfortable with physical queues Likes to be playfully teased Benefits by using pictures to convey meaning Gets frustrated easily Has trouble staying focused Gets upset by loud, sudden noises Gets upset by background noise such as music or talking Yes Sometimes No Please answer each of the following questions (please use back of form if needed): 1. 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? 2. What are favorite activities, movies, music, hobbies or other interests of the rider? 3. Has rider attended LTTW bike camp previously? Yes No If yes, when and what was the outcome? 4. Has he/she ridden with training wheels? Yes No If yes, please provide a brief history. 5. Has rider experienced a bicycling accident? Yes No If yes, please explain? 4

5 Rider Liability Release Rider Name: By signing, I hereby expressly acknowledge that bicycling, like many sports such as swimming, golf, soccer, and gymnastics involves movement and physical activity, and that injury or mishap are possibilities in spite of all reasonable safeguards and precautions taken. Further, I hereby expressly acknowledge that photographs and/or videos of the above rider may be taken by parties outside the control of Shine in connection with participating in bike camp. I acknowledge that Shine has limited or no control over such activities of third parties and has no control over any editing and/or use of such photos and/or video footage. As the parent/guardian of the above rider, I accept such risks as reasonable and proper, and agree to hold harmless the officers, principals, staff and volunteers of KidsAbility, ican Shine, Inc., and Rainbow Trainers, Inc. should injury or mishap occur in this regard. 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 and status. Signature of Parent/Guardian: I give permission for the above rider to be photographed and/or videotaped in print or electronic media by Shine or third parties acting on behalf of Shine. I acknowledge and agree that photographs and videos may be edited and used in whole or in part as desired for the purpose, which may be produced, duplicated, distributed and used for informational, promotional or other public purposes. I understand that photographs and video are not my property and there will be no compensation to me. I understand and authorize the use in writing or otherwise the name or identity of the above rider. Signature of Parent/Guardian: 5

6 Payment & Submission Information Payment of the camp fee is required to process the registration and reserve a session slot. Registration fee $ Total paid $ Select a payment option: Payment by check enclosed payable to: KidsAbility Cash *I require financial assistance. I am able to pay $ * Limited funds are available for financial assistance, and will be shared between families who require it. Please contact us if you have any questions or concerns. Please include payment for the amount you have cited above. Submit your completed application by June 1st to: KidsAbility, attention Heather Granger Mailing Address: 21 Imperial Road S Guelph, ON N1K 1X3 Completed applications may be dropped off at any KidsAbility location: 500 Hallmark Dr. Waterloo 65 Hanson Ave. Kitchener 250 Hespeler Rd. Cambridge 21 Imperial Rd South, Guelph 160 St. David St. South, Fergus Thank you for your interest in the ican Bike program. We are pleased to offer this program and look forward to working with you and your family member in this endeavor to learn to ride a two-wheel bicycle independently. 6