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Menlo Park Bike Club Application
Contact colter@elgrupocycling with any questions
Si tiene preguntas, envíe un correo electrónico colter@elgrupocycling
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* Indicates required question
Email
*
Your email
Rider Name
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Grade
*
3rd
4th
5th
Parent/Guardian Information
***2 Adult contacts required
Parent/Guardian Name
*
Your answer
Relationship to Rider
*
Your answer
Address
*
Your answer
City, State, Zip
*
Your answer
Phone
*
Your answer
Email
*
Your answer
*
Your answer
Parent/Guardian #2
*
Your answer
Address
*
Your answer
City, State, Zip
*
Your answer
Phone # Parent/Guardian #2
*
Your answer
Email Parent/Guardian #2
*
Your answer
When we apply for grants we are often asked to provide demographic information about your participants. Please fill out the following information:
What is the participant's race/ethnicity?
White/Caucasian
Latino/Latina/Hispanic
Black/African American
Native American
Other:
Clear selection
What is your total household income?
$0 - $25,000
$25,001 - $50,000
$50,001 - $75,000
$75,001 - $100,000
$100,001 - $125,000
$125,000 or more
Clear selection
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