CSCC Rider Information Form & Waiver

CSCC Rides, Information Form & Waiver 2022 joining us on rides and activities please submit the info below required once per year.
Upload a photo of yourself*
You will receive a confirmation email with a QR code, save this code this will allow you to check-in easily and fast to CSCC casual rides without having to submit the form for each ride. This form is required once per year for all riders on CSCC casual rides thank you.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Date of Birth*

DayMonthYear
Date
Email*

Confirmation Emailexample@example.com
Gender*

MaleFemale
CLUB OR TEAM *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Blood Type, Use NA if you don't know *
Allergies type NONE if not applicable*
Comorbodities type NONE if not applicable *
Could you please rate your cycling skills and knowledge?

1

2

3

4

5

1 is Beginner, 5 is Experienced
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Email*
example@example.com
Are you willing to participate in a more detailed, anonymous survey?

YesNo
QR Combination
Should be Empty:

CSCC Rides, Information Form & Waiver 2022 joining us on rides and activities please submit the info below required once per year.