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Assessment Reservations

Please note that all fields followed by an asterisk must be filled in.

Select the best option that suites your needs*

	Assessment for CycleSafe
	Assessment for Learn To Ride
	Learn To Ride - 30 minute session(s)
	Assessment for Becoming a Road cyclist
	Assessment for Cycling competition
	Assessment/Preparation for a Cycling Tour

Number of Students

Location for your Assessment *

On the day of your training CALL/TEXT*

Customer, First, Last Name, relationship to the Student (STUDENT,PARENT, GRANDPARENT, GUARDIAN, FREIND, OTHER*

Cell Phone 1-*

Alternative Phone 1-

E-Mail Address*

City and Zip/Postal Code*

Best days & hours to Call you (example: Mon 2:30 AM - 11:45PM)*

Student's Full Name*

Student Gender*

	Male
	Female

Age*

Weight (lbs)*

Height (inches)*

Divide Weight/Height (lbs/")

INSEAM" (floor to highest point between legs)

	have included my inseam measurement in INCHES
	will provide an inseam measurement (INCHES) within the next 24 hours, or I will have to re apply for another Assessment.
	I WILL NOT NEED TO PROVIDE AN INSEAM MEASUREMENT AS I WILL SUPPLY MY OWN BICYCLE, AND/OR TAKE FULL RESPONSIBILITY FOR ALL INJURIES, DUE TO NOT PROVIDING AN INSEAM MEASUREMENT ".

Helmet Options*

ADD'L STUDENT Names/gender/Age/Height/weight/Inseam/Helmet size if required

Do you need our bicycle*

	YES
	NO

OTHER:

S. Cycling Skill level(s)

	I have never ridden a bicycle
	I have only ridden in a parking lot
	I have special needs or requirements
	I have only ridden in my neighborhood
	I have ridden on pathways in parks
	I am an intermediate level cyclist
	I am an advanced level cyclist

T. Do you have any form of disabilities or health issues

	Yes
	No

U. Please explain your Disability(s), health issue, or special needs or requirements

W. Weekdays prefered times

X. Weekends preferred times

Y. Why do you feel you need an assessment or wish to enroll in one of our training programs?

Z. I Acknowledge the following*

You have either asked for an assessment, or we require you to have an assessment; to bring clarity to your abilities, and ensure your success or to determine eligibility. in either case, Your trainer will provide tips and advice, and introduce you to what's to come in your 1st time, 2 hour training session. An assessment is a great way to start you off. you will get your questions answered within your 30 minute assessment.

I agree to the following*

I realize by completing this form, I accept all risks, in inherent injuries, and waive all liabilities and compensations from Born To Ride Bicycle and/or their employees, as well as all organizations/persons that own or manage the lands, that we use for training.

I acknowledge*

We all grow and mature through perseverance, when you make mistakes you learn, when you learn from your mistakes, you develop experience, and become better equipped for life's challenges. In education you learn from others. Other people’s experiences, that they have had made mistakes (trial and error) to attain knowledge. We combine both Experience and knowledge to help you accomplish your goals by taking action. By working with our trainers and having faith, believing you can achieve and actually doing it, you create a higher level of confidence and belief. As you venture more into new experiences, your knowledge and experience accelerates, becoming more successful in life! Eventually you will inspire others to do the same. We look forward to seeing you soon!

I agree to the following*

I do not and will not hold Born To Ride Bicycle or its employees liable for any mental stress or physical injuries. I agree that my trainer has my permission to use any or all techniques and methods to help inspire, motivate, not limited to causing emotional onsets that maybe beyond my comprehension but yield successful results, by encouraging mental growth and developing successful skill sets, in the form of becoming a cyclist and a stronger personality. We define this as strong leadership skill.

I accept*

If I bring my own bike, it has to be in riding condition or else there will be a charge for servicing it.

est. 2009

10 YEARS+

IN BUSINESS

1-855-795-4482

We Service

CENTRAL ONTARIO

OTTAWA, GATINEAU QUEBEC

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