KidsAbility Learn to Ride Programme - Registration Form
** A letter detailing what to bring for the camp will go out a week before the start date, however please be sure that your child has a bike, the pedals have been removed from the bike and a helmet that fits.

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Email *
Child's Name: *
Date of Birth: *
MM
/
DD
/
YYYY
Name(s) of Parent(s): *
Email: *
Mobile Phone: *
Home Telephone:
Address: *
Emergency Contact: *
School: *
Grade: *
Diagnosis (if applicable): *
Physician Name: *
Allergies: *
History of Seizures/Medical Issues: *
Bike Riding Experience: *
Additional Questions / Comments / Information for our Therapists:
Please select the camp(s) you are registering your child in: *
TOTAL AMOUNT IS DUE UPON REGISTRATION
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