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Application Form for Sears National Kids Cancer Ride

Page One

Welcome to the Sears National Kids Cancer Ride National Application Form. Please complete this form if you are interested in participating as a National Rider for the Sears National Kids Cancer Ride in 2010. Along with this Application Form, you may be asked to participate in a phone or face to face meeting with one of the Event Organizers. Successful applicants will also be asked to submit a recent medical certificate, and a commitment to minimum levels of fundraising. You will also be asked to sign an agreement with the Event agreeing to a program of training and nutrition as well as a Release of Liability Waiver. Only one submission per applicant. Good luck! We hope to see you on the 2010 Sears National Kids Cancer Ride.
1. Please provide us with the following information:
4. Do you have any allergies *This question is required.
5. Have you ever smoked cigarettes? *This question is required.
6. How many alcoholic beverages do you consume in an average week? *This question is required.
9. How many times per week do you engage in aerobic activity for periods of longer than 60 minutes? *This question is required.
10. Choose the answer that best describes your current level of fitness? *This question is required.
13. Have you (or someone close to you) ever been impacted by cancer? *This question is required.
14. On a scale from 1-5, please rate the following items: *This question is required.
Space Cell Very LowLowNeutralHighVery High
Confidence you will have sufficient training time for this event? *This question is required
Commitment to following the training and nutritional plan? *This question is required
15. Are you confident that with the appropriate training and nutritional plan, you will be able to complete the Sears National Kids Cancer Ride? *This question is required.
16. Please indicate how you heard about the Sears National Kids Cancer Ride? *This question is required.
17. Please provide three references that support your participation in the Sears National Kids Cancer Ride? *This question is required.
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