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REGISTERING FOR 2021 BASIC RIDER COURSES (Nicolet Area Technical College)

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Vicki Nelson, Administrative Assistant Public Safety
P.O. Box 518, Fieldside Center,
Rhinelander, Wisconsin 54501
p. 715.365.4641 f. 715.365.4668 vnelson@nicoletcollege.edu
REGISTERING FOR 2021 BASIC RIDER COURSES
Basic Rider Course (BRC) - This 16-hour course approved by the Department of Transportation is designed to
teach the beginner or experienced rider the safe techniques to riding a motorcycle. It consists of 6 hours of
classroom and 10 hours of on-cycle instruction. Students successfully completing the course are issued a waiver
for the skills road test at the DMV. Costs for the class are $261.35 for the spring class. Classes after that are TBD.
Basic Rider Course 2 (BRC2) – This 8-hour course approved by the Department of Transportation is for current
motorcycle owners who have been riding for years but have never obtained a Class M motorcycle license.
Students successfully completing the course are issued a waiver for the skills road test at the DMV. There are
additional requirements for this course. Please see BRC2 info. Costs for the class are TBD..
E-Course Information
Due to a new curriculum set by the Motorcycle Safety Foundation, you are required to take an online course prior
to the start of class. Do not take the online class until you are confirmed into a class! The cost of this course is
$19.99 and is separate from the cost of the Motorcycle course. Information for your course will be mailed at the
time of registration confirmation.
TO REGISTER FOLLOW THESE INSTRUCTIONS – MUST BE PRE-REGISTERED
REGISTRATIONS ARE NOT ACCEPTED AT THE TIME OF CLASS
1. Fill out the enclosed REGISTRATION form.
2. Complete the SCHEDULE with your first, second, and third choices for class. This is important! Classes fill up
quickly and you may not get your first choice.
3. The WAIVER RELEASE OF LIABILITY form must be signed. Parent or guardian must also sign for students under
the age of 18 in the presence of a college representative or Notary Public. Registrations received without the
waiver release will NOT be accepted. Also to be completed are the MSF COVID-19 Waiver and Nicolet College
COVID-19 Waiver. Please note the MSF COVID-19 must be signed by a parent/legal guardian if the student is
under 18.
4. If you are interested in attending the same class as a friend/relative/spouse, make sure your registrations are
mailed together in the same envelope or paid here at the same time.
Include the appropriate course fee (checks and money orders should be made out to
Nicolet College).
You must send payment with your registration or it will not be accepted!
Faxed registration should be sent to: (715) 365-4668. Do not use any other fax number, or your
registration could be severely delayed. Faxed registrations MUST be paid via credit card; please fill in
all correct information and sign as requested.
Mail Registrations to:
Nicolet College Motorcycle Program, Attention: Vicki Nelson – Fieldside Center
PO Box 518
Rhinelander, WI 54501
5. A letter of confirmation will be sent out after your registration is received and class assignment has been made.
If you have questions, please call me @ (715) 365.4641 or (800) 544-3039 ext. 4641.
Continuing Education Registration Form
Please Print
__________________________________________
First Name
______
MI
__________________________________________
Last Name
____________________________________
Nicolet Student ID # or Social Security #
______________________________________________________________
Home Mailing Address
Office Use Only
_______________________________
______________________________________
City
_________
State
________________
Zip Code
__________________________
Phone - Home
__________________________
Phone: Cell Work
__________________________
County of Residence
__________________________
Township/Village/City of Residence
_______/_______/_______
Date of Birth
Email Address(Required for receiving certificate of completion)__________________________________________________________________Gender: Male Female
Ethnicity: Are you Hispanic or Latino (regardless of race)? Yes No
Race: (Check all that apply) American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White
Name of Last High School Attended __________________________________________________________ City/State ____________________________________________
Highest Grade Completed ________ Year of High School Graduation/GED/HSED _______________
Highest Credential Earned: No Credential GED HSED HS Diploma Some college (postsecondary credit) Short-term diploma 1-year diploma
2-year diploma Associate degree Baccalaureate Higher than baccalaureate
____________________________________________________________________
THE FOLLOWING INFORMATION IS FOR STATE REPORTING PURPOSES. INFORMATION PROVIDED WILL NOT AFFECT COURSE ADMISSION.
Driver's License Number:
* Senior Fees for person age 62+ are available for Continuing Education classes only
PAYMENT METHOD Check/Money Order (Payable to Nicolet College) MasterCard Visa Discover
If participant is under age 18, please sign below.
Must be signed by parent or legal guardian.
I give permission for my son/daughter to enroll in
the above class(es) at Nicolet College.
____________________________ ________
Signature Date
Card Account Number _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _ Expiration Date: _ _ / _ _
MAIL TO:
Nicolet College
Attn:Vicki Nelson
PO Box 518
Rhinelander, WI 54501
FOR OFFICE USE ONLY
Assigned to Class Number: ____________________
Payment Amount Received: ____________________
FEES ARE DUE WITH REGISTRATION
State of Issue:
Associate degree+additional credential
Verification
Code:
_________ (from signature line on back of credit card)
Name on Card: ________________________________________
Billing Address of Card (if different from above):
_____________________________________________________
_____________________________________________________
SAFETY COURSE -- GENERAL RELEASE, WAIVER & INDEMNIFICATION AGREEMENT rev. 03/20
In consideration for the Wisconsin Department of Transportation/Nicolet Area Technical College, the Motorcycle Safety
Foundation, Inc. (“MSF”), the training sponsor, the owner of the training motorcycle and premises upon which training occurs,
including each of their affiliates, subsidiaries, members, employees, officers, coaches, instructors, aides, and/or agents (the
“Released Parties”), furnishing services, equipment, and/or curriculum and permitting the undersigned to participate in this
Motorcycle Safety Course (the “Course”), the undersigned Participant agrees to all of the following:
Participation in the Course requires physical stamina, motor coordination, and mental alertness. I hereby attest that I have no
known physical or mental limitations and have not used any form of alcohol, or prescription or non-prescription drugs that could
impair my performance in the Course. Participants under 18 years of age must have this form signed by a parent or guardian IN
PERSON at the training location, or this form must be NOTARIZED.
I fully understand and acknowledge that (a) this Agreement is intended to be as broad and inclusive as permitted by the laws of the
State in which the Course is conducted; (b) if any portion of this Agreement is for any reason held invalid or legally unenforceable,
then the balance shall, notwithstanding, continue in full force and legal effect; and (c) I have had the opportunity to ask any
questions about this Agreement and I fully understand its terms and meaning.
READ CAREFULLY: THIS IS A GENERAL RELEASE, WAIVER, ASSUMPTION OF RISK & COVENANT NOT TO SUE
I fully understand and agree that: (a) there are DANGERS AND RISKS OF INJURY, DAMAGE, OR DEATH that exist in my
participation in the Course and use of motorcycles and motorcycling equipment (“Motorcycling Activities”); (b) my participation in the
Course and Motorcycling Activities may result in injury or illness including, but not limited to, BODILY INJURY, DISEASE,
STRAINS, FRACTURES, PARTIAL OR TOTAL PARALYSIS, OTHER AILMENTS THAT COULD
CAUSE SERIOUS DISABILITY, AND DEATH; (c) these risks and dangers may be caused by negligence of Released Parties,
other Course participants, or others, and may arise from foreseeable or unforeseeable causes; and (d) by participating in the
Course and Motorcycling Activities, I, on behalf of myself, my personal representatives and my heirs, hereby knowingly and
voluntarily assume all risks and all responsibility, and agree to release the Released Parties for any injuries, losses and/or
damages, including those caused solely or in part by negligence of the Released Parties or any other person. If I have brought a
motorcycle or helmet to use in the Course, this Agreement applies to any damage that occurs to or from my motorcycle or helmet
during the Course.
I fully understand and agree that, on behalf of myself, my personal representatives and my heirs, I hereby covenant not to sue, and am
relinquishing any and all rights I now have or may have in the future to sue the Released Parties for any and all injury, damage, or death,
whether known or unknown, that I may suffer arising from the Course, or from motorcycle riding or its equipment, including claims based
on the Released Parties’ negligence.
I HAVE READ THIS AGREEMENT AND BY SIGNING BELOW I AGREE TO THE ABOVE TERMS, AND TO ASSUME ALL RISKS
AND RELEASE THE ABOVE-NAMED RELEASED PARTIES FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE
OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.
Participant Name (Printed) – First, Middle, Last License or ID# and State Participant Signature
Date – MM/DD/YYYY Parent/Legal Guardian signature, if Participant under 18 yrs of age Relationship License or ID# and State
___________________________________________ or _______________________________________________
Signature of College Administration if less than 18 years old Notary Public
READ CAREFULLY: THIS IS AN INDEMNIFICATION AND HOLD HARMLESS AGREEMENT
I, on behalf of myself, my personal representatives and my heirs, agree to hold harmless, defend, and indemnify the Released Parties
from any and all claims, suits, or causes of action by any third parties, including Released Parties or other Course participants, for
bodily injury, property damage, or other damages that may arise out of my use of motorcycles and motorcycle equipment or my
participation in the Course, including claims arising from the negligence of Released Parties, other Course participants, or any other
party.
I HAVE READ THIS AGREEMENT AND BY SIGNING BELOW I AGREE TO THE ABOVE TERMS, AND TO ACCEPT LEGAL
RESPONSIBILITY AND PAY FOR ANY LOSS FOR CLAIMS OR LAWSUITS AGAINST THE ABOVE-NAMED RELEASED PARTIES
ARISING FROM MY PARTICIPATION IN THE COURSE.
Participant Name (Printed) – First, Middle, Last License or ID# and State Participant Signature
Date – MM/DD/YYYY Parent/Legal Guardian signature, if Participant under 18 yrs of age Relationship License or ID# and State
___________________________________________ or _______________________________________________
Signature of College Administration if less than 18 years old Notary Public
ACCEPTANCE OF RISKS AND RELEASE OF LIABILITY – STUDENT
This Acceptance of Risks and Release of Liability ("Agreement and Release") is executed by:
_______________________________________ (please print first and last name ("Student"))
and is issued to NICOLET AREA TECHNICAL NICOLET COLLEGE ("NICOLET COLLEGE").
Student is voluntarily participating in an educational program, which includes On-Campus
Instruction ("Activity").
Student understands that there are certain dangers, hazards, and risks inherent in the Activity,
including possible exposure to the novel coronavirus (SARS-CoV-2) or COVID-19 positive
persons. In certain circumstances, these dangers can include severe bodily harm, and even
death.
Student agrees to exercise reasonable care at all times with respect to Student's own health
and safety and with respect to the health and safety of others. Student agrees to abide by all
rules, policies and procedures of the NICOLET COLLEGE specific to the Activity.
In consideration for being allowed to participate in the Activity, Student waives and fully
releases, for himself/herself and for his/her executors, personal representatives,
administrators, assignees, heirs, next of kin, agents, dependents and beneficiaries, any
and all rights, claims for damages, losses, demands, and any other actions or claims of
whatever nature, whether based in law or equity, including but not limited to, the death of
Student and/or any and all injuries, damages or illnesses suffered by Student or
Student’s property which he/she has now, may have, or which may arise against or in
any way related to, or caused by the Student’s participation in, the Activity. NICOLET
COLLEGE, its employees, faculty, board of directors, agents and volunteers shall not be
liable for the foregoing, and Student, on behalf of himself/herself and for his/her
executors, personal representatives, administrators, assignees, heirs, next of kin,
agents, dependents and beneficiaries, hereby expressly releases NICOLET COLLEGE, its
employees, faculty, board of directors, agents and volunteers from any and all such
claims.
Moreover, Student, for himself/herself and for his/her executors, personal
representatives, administrators, assignees, heirs, next of kin, agents, dependents and
beneficiaries hereby agrees to indemnify and hold harmless the NICOLET COLLEGE, the
NICOLET COLLEGE'S employees, faculty, board of directors, agents and volunteers from
and against any liabilities, claims, damages, losses, including incidental and
consequential losses, and expenses, including defense expenses and costs, attributable
to losses, including, but not limited to bodily injury, sickness, disease or death, or to
injury or destruction of any tangible property, arising out of, or resulting from or caused
by the acts or omissions of the Student.
This indemnification obligation exists regardless of whether such claims, damages,
losses or expenses are caused solely by Student or are contributed to in part by
NICOLET COLLEGE, its employees, faculty, board of directors, agents and volunteers.
However, the law of the state of Wisconsin should injury or damage occur may provide
for the apportionment of the loss.
This release of liability does not, however, apply to any intentional or reckless acts or
conduct by the NICOLET COLLEGE its employees, faculty, board of directors, agents or
volunteers.
By signing this document, Student acknowledges that s/he is fully informed of the contents of
this Agreement and Release and represents that s/he understands it. Student is not relying on
any oral or written representations, statements or inducements, apart from those made in this
Agreement and Release.
Further, Student understands that signing this form, together with the limitation and waiver of
liability contained herein, or an alternative form that is acceptable to the Nicolet College, is
necessary for the Student to participate in the Activity. Student further agrees it has had the
opportunity to negotiate possible alternate terms with the Nicolet College and that the Nicolet
College has made representatives available to Student for such negotiations.
By signing this Agreement and Release, you give up substantial legal rights. Read and
understand this entire document before you sign it.
Student Date
2020/5/17_JRG revision
Rev. 06/20
Waiver and General Release of Liability Relating to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization.
COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed
to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in
the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of
spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has
shown that COVID-19 can cause serious and potentially life-threatening illness and even death.
The Motorcycle Safety Foundation, Inc. (“MSF”), the training sponsor, the owner of the training motorcycle and
premises upon which training occurs, including each of their affiliates, subsidiaries, members, employees, officers,
coaches, instructors, aides, and/or agents (the “Released Parties”) cannot prevent you from becoming exposed to,
contracting, or spreading COVID-19 while participating in this Motorcycle Safety Course or utilizing the Released
Parties’ services or premises (collectively, the “Course”). It is not possible to prevent against the presence of the
disease. Therefore, if you choose to participate in the Course, you may be exposing yourself to and/or increasing
your risk of contracting or spreading COVID-19.
ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose
to accept the risk of contracting COVID-19 for myself, and for my family members or others who I may expose, in order
to participate in the Course. These services are of such value to me that I accept the risk of being exposed to, contracting,
and/or spreading COVID-19 in order to participate in the Course.
WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against the
Released Parties in connection with exposure, infection, and/or spread of COVID-19 related to my participation in
the Course. I understand that this waiver means I give up my right to bring any claims including for personal injuries,
death, disease or property losses, or any other loss, including but not limited to claims of negligence, and give up any
claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.
OTHER TERMS: I fully understand and agree that (a) this Release is intended to be as broad and inclusive as permitted
by the laws of the State in which the Course is conducted; (b) if any portion of this Agreement is for any reason held
invalid or legally unenforceable, then the balance shall, notwithstanding, continue in full force and legal effect; and (c) I
have had the opportunity to ask any questions about this Agreement and I fully understand its terms and meaning.
I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS WAIVER AND
GENERAL RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS
CONCERNING LIABILITY AS DESCRIBED ABOVE:
Signature: ____________________________ Date: ______________________
Name (printed): ____________________________
I am the parent or legal guardian of the minor named above. I have the legal right to consent to and, by signing below, I
hereby do consent to the terms and conditions of this Waiver and General Release.
Signature: ____________________________ Date: ______________________
Name (printed): ____________________________
2021 Nicolet College BRC & BRC Schedule – Schedule is subject to change
Indicate 1
st
, 2
nd
& 3
rd
Choice
Class
Dates
Location
Fee
Days
Times
9662
4/24-25
WC206
$261.35
Saturday & Sunday
8:30am – 4:30pm
3000
5/3-5/6
WC206
TBA
Monday, Tuesday, Wednesday, & Thursday
4:00pm – 8:00pm
3004
5/15-16
WC 206
TBA
Saturday & Sunday
8:30am – 4:30pm
3001
5/24-5/27
WC206
TBA
Monday, Tuesday, Wednesday, & Thursday
4:00pm – 8:00pm
3011
5/29
WC206
TBA
Saturday
8:30am – 4:30pm
3005
6/5-6
WC206
TBA
Saturday & Sunday
8:30am – 4:30pm
3006
6/12-13
WC206
TBA
Saturday & Sunday
8:30am – 4:30pm
3002
6/14-17
WC206
TBA
Monday, Tuesday, Wednesday, & Thursday
5:00pm – 9:00pm
3012
6/19
WC206
TBA
Saturday
8:30am – 4:30pm
3007
6/26-27
WC206
TBA
Saturday & Sunday
8:30am – 4:30pm
3017
7/12-7/15
WC206
TBA
Monday, Tuesday, Wednesday, & Thursday
5:00pm – 9:00pm
3013
7/16
WC206
TBA
Friday
8:30am – 4:30pm
3016
7/17-18
WC206
TBA
Saturday & Sunday
8:30am – 4:30pm
3009
7/24-25
WC206
TBA
Saturday & Sunday
8:30am – 4:30pm
3014
7/31
WC206
TBA
Saturday
8:30am – 4:30pm
3003
8/2-8/5
WC206
TBA
Monday, Tuesday, Wednesday, & Thursday
5:00pm – 9:00pm
3010
8/14-15
WC206
TBA
Saturday & Sunday
8:30am – 4:30pm
3015
8/21
WC206
TBA
Saturday
8:30am – 4:30pm
3018
8/28-29
WC206
TBA
Saturday & Sunday
8:30am – 4:30pm
5000
9/11-12
WC206
TBA
Saturday & Sunday
8:30am – 4:30pm
5002
9/25
WC206
TBA
Saturday
8:30am – 4:30pm
5001
10/2-3
WC206
TBA
Saturday & Sunday
8:30am – 4:30pm
For more information please contact Vicki Nelson at 715.365-4641 or email vnelson@nicoletcollege.edu
*BRC2 course is designed for current motorcycle owners who have been riding for years without their motorcycle endorsement on their license.
Riders for BRC2 course will be required to use their own motorcycle for class.
You must be able to pass the skills test for BRC and BRC2 classes to obtain the WDOT Skills Road Test Waiver.
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REGISTERING FOR 2021 BASIC RIDER COURSES (Nicolet Area Technical College)

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Completed 4 February 2021

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