Ride Guides Rating System

Thank you for your interest in Ride Guides! Please fill out the form below with as much information as you can. If you are under 18, please have a Parent or your Guardian assist you with completing this form. Thanks for saving our trees!

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Participant Information

Participant First Name: *	Participant Last Name: *
Age:

Parent / Guardian Information

Parent / Guardian Name:	Home Phone:
Work Phone:	Mobile Phone:

Emergency Contact Information (Primary)

Emergency Contact Name:	Home Phone:
Work Phone:	Mobile Phone:
Relationship:

Emergency Contact Information (Alternate)

Emergency Contact Name:	Home Phone:
Work Phone:	Mobile Phone:
Relationship:

Family Doctor Information

Family Doctor Name:

Family Doctor Phone:

Medical History

List all relevant illnesses, surgeries or medical conditions:

Allergies

List all allergies and medications used to control them:

Permission

I hereby grant permission to all Ride Guides Employees and Ride Guides Contractors to offer and perform First-Aid treatment on me in the event of an emergency:
Yes No