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Consent and Authorization for Minor Athlete Transportation with Unrelated Applicable Adult

Consent and Authorization for Minor Athlete Transportation with Unrelated Applicable Adult

I, the undersigned, certify that I am the parent or legal guardian of the below named Minor Athlete. I understand that my written consent and authorization is required in order for Minor Athlete to ride in a vehicle alone with an unrelated Applicable Adult. In connection with and in consideration of Minor Athlete riding in a vehicle alone with an unrelated Applicable Adult I, as Minor Athlete’s parent or legal guardian, hereby represent and agree as follows:

1) I agree to allow the Minor Athlete to ride in a vehicle alone with the unrelated Applicable Adult listed below.

2) I agree that I have had the opportunity to review USA Cycling’s SafeSport Program and Minor Athlete Protection Policies, available at https://www.usacycling.org/resources/safesport/usacpolicies;

3) I authorize and consent to the release and disclosure of this consent form, Minor Athlete’s name, and other relevant information necessary to demonstrate my consent to Minor Athlete’s participation.

I certify that I am 18 years of age or older and the parent or legal guardian of the Minor Athlete. In addition, I certify that I have read, fully understand, and agree to the terms of this Authorization, and I sign it voluntarily with the full knowledge of its significance.

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Additional Information

Name of Coach and/or Adult/s providing transportation

Date/s of the transportation
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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