cycling

VOLUNTEER FOX CITIES

Cycling Without Age +Trishaw Transit Volunteer Application

Thank you for your interest in being a volunteer for Cycling Without Age + Trishaw Transit. Please read the following information carefully (including the linked forms), when you fill you will be providing your signature acknowledging that you have read and understand all of this information.

Pilots MUST:

  • Have a valid Wisconsin drivers license
  • Have car insurance (if they are towing the trishaw)
  • Have valid pilot certification and attend complete volunteer training certification with yearly renewal and online certification
  • Adhere to COVID-19 guidelines for each facility hosting an event.

To read all the program guidelines – CLICK HERE

To read the Cycling Without Age Volunteer Consent and Waiver of Liabilities – CLICK HERE

Once you have read and agree to the above information, please fill out the form below. Once you have submitted the form, someone will contact you as soon as they are available! THANK YOU!

Cycling Without Age + Trishaw Transit Enrollment

Cycling Without Age + Trishaw Transit Enrollment

Address *
Address
City
State/Province
Zip/Postal
Country
Do you drive a vehicle? *
I carry at least the minimum liability insurance: $25,000 for injury or death of one person; $50,000 for injury or death of two or more people; and $10,000 for property damage. Uninsured motorist coverage of at least $25,000/$50.000 each for bodily injury only is also mandatory.

Demographic Information - As part of our federal grant we are required to report demographics to the Corporation for National and Community Service. Please colmplete the following:

Military Service (Check all that apply) *
Marital Status *
Ethnicity/Race *
Are you fluent in a language other than English? *
Do you have a disability? *
Highest level of education completed *
If you are 55+ and are interested in enrolling in the Americorps Seniors RSVP 55+ Volunteer Program, please complete the following section. RSVP volunteers are covered by supplemental accident and personal liability insurance plus a death benefit while performing volunteer duties. This coverage is automatic and free to you as long as you are an active volunteer. An active member is one who reports volunteer hours at least every six months to Volunteer Fox Cities.
Beneficiary address
Beneficiary address
City
State/Province
Zip/Postal
Country

SIGNATURE

By signing this document I am stating that all the above information is true and that I agree to the following: - I understand that I am responsible to decline any volunteer work that I may not be physically able to tolerate and I waive any liability to Volunteer Fox Cities for injury. - If I use my personal automobile in my volunteer service, I will arrange to keep in effect my automobile liability insurance equal to or greater than they minimum requirements of the state of Wisconsin. I will also keep in effect a valid Wisconsin drivers license. - I authorize the release of my name and application information to any agency where I may volunteer. - I understand that a background check may be performed and I authorize the release of my information for that purpose. - I understand that in my volunteer capacity I am required to keep both agency and client information confidential. I agree to protect this information to the best of my ability and not disclose it during or after my service as a volunteer has ended. - I give Volunteer Fox Cities permission to use my picture in its publications, website and social media.

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