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Kids of Mud Registration Form 2024
May - End of June 2024
Thursdays & Sundays from 6pm-7pm
HyLife Back Forty - Multi Use Trail Park
Neepawa, MB
$105.00 Per Participant
Note:
2024 Manitoba Cycling Association License is required.
Must be purchased after successfully completing THIS form. Email with link to register with the MCA will be sent once registration confirmed.
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* Indicates required question
Childs first name
*
Your answer
Childs last name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
MB Health Number (6 digit)
*
Your answer
PHIN (9 digit))
*
Your answer
Please list any medical concerns
*
Your answer
Parents Name (First & Last)
*
Your answer
Parent First Name
*
Your answer
Parent Last Name
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Emergency Contact (First & Last Name)
*
Your answer
Phone Number
*
Your answer
Registration Fee is $40.00
Payments can be made by:
1. eTransfer to
accounts@neepawa.ca
(please include Kids of Mud and your child's name in memo)
2. Credit Card over the phone (by calling 204-476-7600)
3. In person with cash or cheque (275 Hamilton Street Neepawa, MB
THANK YOU FOR RIDING WITH US! Once you click submit below, your registration has been summitted.
We look forward to a fun biking season!
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