2024 Court-Ordered Community Service Application
Thank you for your interest in performing Community Service with the Salt Lake City Bicycle Collective. Please complete this application prior to beginning your volunteer hours with the Salt Lake City Bicycle Collective.

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Please read the statements below to ensure your eligibility to complete your court-ordered community service hours with the SLC Bicycle Collective. Check each line indicating you have read and understand the statement.
First Name: *
Last Name: *
Birthdate: *
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Email Address: *
What emails do you want to receive from the Bicycle Collective? (check all that apply) *
Required
Current Mailing Address: *
Phone: *
Emergency Contact Name: *
Emergency Contact Phone Number: *
What is your present occupation? *
What is your level of bike mechanic proficiency? *
How did you hear about the Bicycle Collective? (check all that apply) *
Required
Have you ever been convicted of a felony? *
If yes, please explain, otherwise, skip this portion:
Are you required to register as a sex offender in the state of Utah? *
Number of hours to serve:
Date hours must be served by:
Caseworker/Probation Officer Name:
Caseworker/Probation Officer Number:
Court-Ordered Community Service Program Agreement
By entering your name below, you hereby represent to the Salt Lake City Bicycle Collective that you have been given an opportunity to perform community service in lieu of and/or in addition to being fined and/or incarcerated. In that regard, you have voluntarily agreed to perform such work as shall be assigned to you from time to time and to comply with such instructions and regulations as are communicated to you by authorized representatives of the Salt Lake City Bicycle Collective. You acknowledge that such work is to be performed by you without compensation of any kind, financial or otherwise.

You also understand that should your work performance be found to be unsatisfactory or unacceptable, your opportunity of fulfilling community service hours with the Salt Lake City Bicycle Collective can be terminated and that this fact will be communicated to the court responsible for your sentence.
Type your full name: *
Volunteer Waiver of Claims, Assumption of Risk, and Release of Liability
1. VOLUNTARY PARTICIPATION

I acknowledge that I have voluntarily agreed to participate in the Salt Lake City Bicycle Collective’s (“SLCBC”) Volunteer Program (the "Program”).  As a volunteer, I understand that I will not be paid for my services and that I will not be eligible for any Workers Compensation benefits. I further agree that my participation in the project may be terminated at any time by SLCBC or by me.

2. EXPRESS ASSUMPTION OF RISK ASSOCIATED WITH VOLUNTEER ACTIVITIES

I do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with the volunteer services performed on behalf of SLCBC and for which I am about to engage in. I acknowledge that I have read and understand the following:

I AM AWARE THAT IN VOLUNTARILY PARTICIPATING IN THE PROGRAM, I MAY BE EXPOSED TO PERSONAL INJURY OR DEATH OR DAMAGE TO MY PROPERTY AS A RESULT OF MY ACTIVITIES, THE ACTIVITIES OF OTHER VOLUNTEERS AND PARTICIPANTS - WHO MAY NOT AT ALL TIMES ACT WITH DUE CARE- OR THE CONDITIONS UNDER WHICH MY VOLUNTEER SERVICES ARE PERFORMED.

I ACKNOWLEDGE THE POSSIBLE RISKS, INCLUDING, BUT NOT LIMITED TO THE EXISTENCE OF HAZARDOUS MATERIALS, THE USE OF TOOLS, CUTTING TOOLS, AND POWER TOOLS IN THE PROGRAM, AND I KNOW AND APPRECIATE THOSE RISKS.  I UNDERSTAND THAT BICYCLING AND BICYCLE REPAIR ARE HAZARDOUS ACTIVITIES AND THAT INJURIES ARE A COMMON AND ORDINARY OCCURRENCE. I RECOGNIZE THAT THERE ARE RISKS INCLUDING, BUT NOT LIMITED TO: UNEVEN AND/OR SLIPPERY RIDING CONDITIONS, VARYING SLOPES, VARIATIONS IN TERRAIN, VARIATION IN BICYCLE CONDITION, VARIATION IN WEATHER, DEBRIS, AND COLLISIONS WITH OTHER PERSONS, OTHER BIKES AND VEHICLES, AND NATURAL AND MANMADE OBJECTS. I FREELY ASSUME THESE RISKS AND VOLUNTARILY ELECT TO PARTICIPATE IN THESE ACTIVITIES.

I HAVE RECEIVED NO ASSURANCE THAT THESE ACTIVITIES WILL BE SAFE AND I ACKNOWLEDGE THE POSSIBILITY OF NEGLIGENT WRONGDOING BY ME AND BY OTHER VOLUNTEERS.  WITH KNOWLEDGE OF THESE RISKS, I VOLUNTARILY UNDERTAKE TO ENCOUNTER THESE KNOWN RISKS AND I EXPRESSLY AGREE TO ASSUME ANY AND ALL RISKS OF PERSONAL INJURY OR DEATH OR DAMAGE TO MY PROPERTY. I ALSO UNDERSTAND THAT ANY DAMAGE TO MY PERSONAL VEHICLE DURING MY VOLUNTEER ASSIGNMENT IS NOT COVERED BY SLCBC’s INSURANCE.

I further understand that the description of risks herein is not complete and that unknown or unanticipated risks may result in injury, illness, death or damage to property.

3. RELEASE OF LIABILITY

In consideration of the opportunity afforded me to participate in the Program, I hereby agree that I, my successors, assignees, heirs, guardians and legal representatives will not make any claim against SLCBC,, its affiliated sponsors, organizations, its officers, employees, volunteers, or directors, the suppliers of any materials or equipment that are used during the Program for known or unknown injury, damage, or death resulting from the negligent acts or omissions of any person, including my own, volunteer, representative of SLCBC or entity, however caused, arising from my participation in the Program.

Without limiting the generality of the foregoing, I hereby waive and release any rights, actions or causes of action resulting in my personal injury, or death or damage to my property, sustained in connection with my participation in the Program; provided, however, that the injury, death or damage was not caused by an act or omission that was reckless, wanton or intentional. I hereby knowingly, consciously, intelligently, and freely intend to abandon and release all unknown claims which may arise from my participation in this Program. I certify that I have read this entire Agreement, Assumption, and Release. This release shall be binding to the fullest extent permitted by law. If any provision of this release is found to be unenforceable, the remaining terms shall be enforceable and shall be interpreted under the laws of Utah.

4. IMAGE USE

I understand that while working on a project I may be photographed or videographed by representatives of SLCBC, its affiliates, employees or members of the media. I agree to allow my photo, video or film likeness through any media, including any electronic and social media to be copyrighted and used for any legitimate purpose by SLCBC or its assigns. I hereby waive, in perpetuity, any right of publicity or privacy that I may have in my name or likeness without expectation of remuneration.


Type your full name in the space below. By entering your name below, you acknowledge that you have read SLC Bicycle Collective's Release of Liability & Assumption of Risk Agreement and you fully understand its terms and understand that you have given up legal rights and agree freely and voluntarily without any inducement. *
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