Spring 2021  Virtual Job Skill Program Registration
Spring 2021 Virtual Job Skill Program hosted by Open Roads Bike Program on Tuesday evenings from 5pm - 6pm on May 4th through June 21st

Once you complete this form and click "submit" we will be in touch to confirm your student's spot in line for a program session. Please call Kyrone with any questions: 269-365-9142.

Students ages 13 to 17 years old are eligible to participate. Registered students must commit to attending five of the eight sessions. Participants will be eligible to receive a special prize!

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Email *
Parent/Guardian Name *
Student Phone Number *
Student's Home Address *
Student's Name (first and last): *
Student's Birthday: *
Race/Ethnicity
Student's Pronouns (she/her, they/them, etc.): *
Student's Favorite Color(s): *
T-Shirt Size: *
Please note any and all allergies your child has (food, beverage)
Does your student have access to a laptop? *
By electronically signing this form, I give my child permission to participate in an 8 week virtual program at Open Roads.  I understand this is a virtual program and my child will attend as many sessions as possible (minimum of 5 out of 8 weeks). I understand that by completing this form, this does not guarantee that my child will be enrolled in the program.
Thank you for registering!
A copy of your responses will be emailed to the address you provided.
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